Request for Social Security Statement

ICR 200109-0960-013

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
38009 Migrated
ICR Details
0960-0466 200109-0960-013
Historical Active 200103-0960-003
SSA
Request for Social Security Statement
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/24/2001
Retrieve Notice of Action (NOA) 09/24/2001
  Inventory as of this Action Requested Previously Approved
07/31/2004 07/31/2004 05/31/2004
1,100,000 0 3,000,000
91,667 0 250,000
0 0 0

Form SSA-7004 is used by members of the public to request information about their Social Security earning records and to get an estimate of their potential benefits. SSA provides information, in response to the request, from the individual's personal Social Security record. The respondents are Social Security numberholders who have covered earnings on record.

None
None


No

1
IC Title Form No. Form Name
Request for Social Security 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 1,100,000 3,000,000 0 -1,900,000 0 0
Annual Time Burden (Hours) 91,667 250,000 0 -158,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
09/24/2001


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