Information Collection

Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100

IC 9428 under ICR 200711-0960-001 · OMB 0960-0525.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0525 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7050-F4 Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100	Form
SSA-7050-F4 Request fo Social Security Earning Information ssa7050.pdf	Form

IC Title:

Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810 20 CFR 401.100

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-7050-F4	Request fo Social Security Earning Information	ssa7050.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60,000

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	60,000	-27,000	87,000
Annual IC Time Burden (Hours)	11,000	-4,950	15,950
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.