Information Collection

Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100

IC 9428 under ICR 201010-0960-008 · OMB 0960-0525.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0525 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-7050-F4 Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100 Form
SSA-7050-F4 Request fo Social Security Earning Information SSA-7050 Revised Final Mock-Up.pdf Form
SSA-7050.pdf SSA-7050 Current Version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810 20 CFR 401.100

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7050-F4	Request fo Social Security Earning Information	SSA-7050 Revised Final Mock-Up.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: 60,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	60,400	400	60,000
Annual IC Time Burden (Hours)	11,073	73	11,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-7050 Current Version	SSA-7050.pdf	02/01/2011

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