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Federal forms, ICRs, and supporting documents

Information Collection

Enumeration at Birth - Hospital Staff Relaying State Birth Certificate Data to SSA

IC 243560 under ICR 202605-0960-009 · OMB 0960-0066.

Documents and Forms
Document Name
Document Type
Other-Sample Form for EAB (currently
Other-Sample Form for EAB (currently
Information Collection (IC) Details

View Information Collection (IC)

Enumeration at Birth - Hospital Staff Relaying State Birth Certificate Data to SSA
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 422.103-422.110

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Sample Form for EAB (currently in use in Michigan) Sample State form for EAB (Michigan Parent Information Worksheet).pdf Yes Yes Fillable Fileable Signable
Other-Sample Form for EAB (currently in use in Alaska) Sample State for EAB (Alaska Parent Worksheet Template for State Issued EAB SSN Request).pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

3,599,746 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,599,746 0 0 0 0 3,599,746
Annual IC Time Burden (Hours) 2,399,831 0 0 0 0 2,399,831
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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