Work History Report

Work History Report

OMB: 0960-0578

IC ID: 9542

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Work History Report
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1560 20 CFR 404.1565 20 CFR 404.1512 20 CFR 416.965 20 CFR 416.960 20 CFR 416.912

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-3369 Work History Report SSA-3369 final.pdf No   Paper Only

Income Security General Retirement and Disability

 

1,090,346 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,090,346 0 0 1,069,346 0 21,000
Annual IC Time Burden (Hours) 1,090,346 0 0 1,069,346 0 21,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Work History Report (current version) SSA-3369-BK.pdf 11/10/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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