REQUEST FOR EARNINGS AND BENEFIT ESTIMATE STATEMENT

ICR 198901-0960-006

OMB: 0960-0466

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
115610 Migrated
ICR Details
0960-0466 198901-0960-006
Historical Active 198811-0960-001
SSA
REQUEST FOR EARNINGS AND BENEFIT ESTIMATE STATEMENT
Extension without change of a currently approved collection   No
Regular
Approved without change 03/14/1989
Retrieve Notice of Action (NOA) 01/19/1989
  Inventory as of this Action Requested Previously Approved
03/31/1992 03/31/1992 11/30/1991
6,000,000 0 6,000,000
500,000 0 500,000
0 0 0

THE INFORMATION WILL BE USED TO PROVIDE A STATEMENT OF EARNINGS, QUARTERS OF COVERAGE AND FUTURE BENEFIT ESTIMATES TO CERTAIN WORKERS AND SELF-EMPLOYED INDIVIDUALS. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS REQUESTING PERSONAL EARNINGS AND BENEFIT STATEMENTS.

None
None


No

1
IC Title Form No. Form Name
REQUEST FOR EARNINGS AND BENEFIT ESTIMATE STATEMENT SSA-7004

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 6,000,000 6,000,000 0 0 0 0
Annual Time Burden (Hours) 500,000 500,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/19/1989


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