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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.