Information Collection

Request for Social Security Statement--Internet Version

IC 180317 under ICR 200705-0960-016 · OMB 0960-0466.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0466 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-7004--Internet Version.pdf www.ssa.gov/mystatement/	Other-Internet Screens & Instrructio

IC Title:

Request for Social Security Statement--Internet Version

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810

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
Other-Internet Screens & Instrruction			SSA-7004--Internet Version.pdf	http://www.ssa.gov/mystatement/	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 351,668

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	351,668	351,668
Annual IC Time Burden (Hours)	29,306	29,306
Annual IC Cost Burden (Dollars)	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.