Information Collection

Certificate Electing Social Security Coverage And Certificate Of Election Of Coverage

IC 169788 under ICR 198402-1545-042 · OMB 1545-0005.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

CERTIFICATE ELECTING SOCIAL SECURITY COVERAGE AND CERTIFICATE OF ELECTION OF COVERAGE

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SS-16	No	No
Form	SS-15A SUPP	No	No
Form	SS-15	No	No
Form	SS-15A	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,640

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20,540	-100	20,640
Annual IC Time Burden (Hours)	8,831	-43	8,874
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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

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