Information Collection

Statement of Self-Employment Income

IC 43691 under ICR 200905-0960-002 · OMB 0960-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-766 Statement of Self-Employment Income	Form
SSA-766 Statement of Self-Employment Income SSA-766 Final.pdf	Form

IC Title:

Statement of Self-Employment Income

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 404.110 20 CFR 404.1096 20 CFR 404.610 20 CFR 404.611 20 CFR 404.101 20 CFR 422.405

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-766	Statement of Self-Employment Income	SSA-766 Final.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: 2,500

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	2,500	-2,500	5,000
Annual IC Time Burden (Hours)	208	-209	417
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.