Information Collection

SSA-L3365, Request for Employee Information

IC 178761 under ICR 201006-0960-009 · OMB 0960-0508.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0508 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-L3365 SSA-L3365, Request for Employee Information	Form
SSA-L3365 Request for Employee Information decor3365-07.pdf	Form

IC Title:

SSA-L3365, Request for Employee Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.120

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-L3365	Request for Employee Information	decor3365-07.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: 173,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	173,100	173,100
Annual IC Time Burden (Hours)	28,850	28,850
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.