Information Collection

COVID Screener Questions and Appointment Check-In - Telephone Check-In

IC 250430 under ICR 202210-0960-005 · OMB 0960-0066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0066 can be found here:

Documents and Forms

Document Name Document Type
Express Interviews Pre-Screening Questions - Revised.pdf Other-Telephone Script
Express Interviews Pre-Screening Questions - Revised.pdf Other-Telephone Script
Express Interviews Pre-Screening Questions - Current.pdf Express Interviews Pre-Screening Questions - Current IC Document
Express Interviews Pre-Screening Questions - Current.pdf Express Interviews Pre-Screening Questions - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	COVID Screener Questions and Appointment Check-In - Telephone Check-In	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 422.103 - 422.110

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Telephone Script			Express Interviews Pre-Screening Questions - Revised.pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,615,540	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-6,615,540	6,615,540
Annual IC Time Burden (Hours)	-7,056,576	7,056,576
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Express Interviews Pre-Screening Questions - Current	Express Interviews Pre-Screening Questions - Current.pdf	03/31/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.