Information Collection

SSA-L3365, Request for Employee Information

IC 178761 under ICR 200702-0960-006 · OMB 0960-0508.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0508 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-L3365 SSA-L3365, Request for Employee Information Form
SSA-L3365 Request for Employee Information decor3365-07.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-L3365, Request for Employee Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.120

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-L3365	Request for Employee Information	decor3365-07.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 173,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	173,100	173,100
Annual IC Time Burden (Hours)	28,850	28,850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.