Information Collection

SSA-L2765, Request for Self-Employment Information

IC 9413 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-L2765 SSA-L2765, Request for Self-Employment Information	Form
SSA-L2765 Request for Self-Employment Information decor2765-07.pdf	Form

IC Title:

SSA-L2765, Request for Self-Employment Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 422.120

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-L2765	Request for Self-Employment Information	decor2765-07.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: 15,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15,400	-2,984,600	3,000,000
Annual IC Time Burden (Hours)	2,567	-497,433	500,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.