Information Collection

SSA - Reporting a Change That May Affect Your Extra Help

IC 187637 under ICR 200812-0960-012 · OMB 0960-0723.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0723 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1026-SCE SSA - Reporting a Change That May Affect Your Extra Help	Form and Instruction
SSA-1026-SCE SSA - Reporting a Change That May Affect Your Extra Help SSA-1026-OCR-SM-SCE (12-2009).pdf	Form and Instruction

IC Title:

SSA - Reporting a Change That May Affect Your Extra Help

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 418.3125

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 and Instruction	SSA-1026-SCE	SSA - Reporting a Change That May Affect Your Extra Help	SSA-1026-OCR-SM-SCE (12-2009).pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,984

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
Annual Number of Responses for this IC	11,984	11,984
Annual IC Time Burden (Hours)	3,595	3,595
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.