Information Collection

Ssa-1002

IC 8936 under ICR 201007-0960-013 · OMB 0960-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1002 (revised) SSA-1002	Form
SSA-1002 (revised) Statement of Agricultural Employer (Years Prior to 1988) SSA-1002 (revised).pdf	Form
SSA-1002.pdf SSA-1002 (current)	IC Document

IC Title:

SSA-1002

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 404.802 20 CFR 404.1056 20 CFR 404.702

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-1002 (revised)	Statement of Agricultural Employer (Years Prior to 1988)	SSA-1002 (revised).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: 7,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	7,500	-67,500	75,000
Annual IC Time Burden (Hours)	3,750	-33,750	37,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1002 (current)	SSA-1002.pdf	09/07/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.