SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT QUESTIONNAIRIES

ICR 199109-0960-005

OMB: 0960-0476

Federal Form Document

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Document
Name
Status
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IC Document Collections
ICR Details
0960-0476 199109-0960-005
Historical Active 198906-0960-010
SSA
SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT QUESTIONNAIRIES
No material or nonsubstantive change to a currently approved collection   No
Emergency 09/23/1991
Approved with change 09/23/1991
Retrieve Notice of Action (NOA) 09/23/1991
  Inventory as of this Action Requested Previously Approved
09/30/1991 09/30/1991 09/30/1991
12,950 0 12,950
2,242 0 2,242
0 0 0

THE INFORMATION COLLECTED ON THESE FORMS WILL BE USED BY THE SOCIAL SECURITY ADMINISTRATION TO ASCERTAIN THE VALUE OF PROVIDING PERSONAL SOCIAL SECURITY INFORMATION TO INDIVIDUALS WHO HAVE NOT REQUESTED IT. THE AFFECTED PUBLIC WILL CONSIST OF INDIVIDUALS WHO ARE AGES 19 TO 64, AND ARE SELECTED FOR THIS SURVEY.

None
None


No

1
IC Title Form No. Form Name
SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT QUESTIONNAIRIES SSA-7005, 4, 5

  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 12,950 12,950 0 0 0 0
Annual Time Burden (Hours) 2,242 2,242 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.
09/23/1991


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