Information Collection

Self-Employment/Corporate Officer Work and Earnings Monitoring

IC 195407 under ICR 201011-3220-003 · OMB 3220-0202.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0202 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-252 (xx-xx) Self-Employment/Corporate Officer Work and Earnings Monitoring	Form
G-252 (xx-xx) Self-Employment/Corporate Officer Work and Earnings Moni G-252 (proposed).pdf	Form
RL-252.doc RL-252 - G-252 Transmittal Letter	IC Document
SSA-4184.pdf SSA-4184	IC Document

IC Title:

Self-Employment/Corporate Officer Work and Earnings Monitoring

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 220.17 -220.20 20 CFR 216

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	G-252 (xx-xx)	Self-Employment/Corporate Officer Work and Earnings Monitoring	G-252 (proposed).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System

FR Citation: 75 FR 43727

Number of Respondents: 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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RL-252 - G-252 Transmittal Letter	RL-252.doc	11/23/2010
SSA-4184	SSA-4184.pdf	11/23/2010

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