Information Collection

Internet Request for Replacement SSA-1099/1042S

IC 9556 under ICR 200907-0960-008 · OMB 0960-0583.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0583 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OMB_Screen_Package screens revised.pdf	Other-Internet Screens for Request f

IC Title:

Internet Request for Replacement SSA-1099/1042S

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 401.45

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 for Request for Replacement of Forms SSA-1099/SSA-1042S			OMB_Screen_Package screens revised.pdf		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: 136,455

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	Previously Approved
Annual Number of Responses for this IC	136,455	115,455	21,000
Annual IC Time Burden (Hours)	22,743	19,243	3,500
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.