Information Collection

Self-Employment/Corporate Officer Questionnaire

IC 43702 under ICR 200902-0960-007 · OMB 0960-0487.

Documents and Forms

Document Name Document Type
Form SSA-41884 Self-Employment/Corporate Officer Questionnaire Form
SSA-41884 Self-Employment/Corporate Officer Questionnaire SSA-4184.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Self-Employment/Corporate Officer Questionnaire	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 404.435(e) 20 CFR 404.446

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-41884	Self-Employment/Corporate Officer Questionnaire	SSA-4184.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50,000	50,000
Annual IC Time Burden (Hours)	16,667	16,667
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.