Information Collection

Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits

IC 194025 under ICR 201101-1545-017 · OMB 1545-2187.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2187 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 8955-SSA Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits	Form
09i8955SSAdrxml-crop26OMB.pdf	Instruction
8955-SSA Annual Registration Statement Identifying Separated Part Form 8955-SSA_DRAFT.pdf	Form
8955_SSA_02_07_2011_brdn_spec.pdf 2011 Burden for Form 8955-SSA	IC Document

IC Title:

Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	8955-SSA	Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits	Form 8955-SSA_DRAFT.pdf		Yes	Yes	Fillable Fileable
Instruction			09i8955SSAdrxml-crop26OMB.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200,000	200,000
Annual IC Time Burden (Hours)	166,000	166,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2011 Burden for Form 8955-SSA	8955_SSA_02_07_2011_brdn_spec.pdf	02/07/2011

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