Information Collection

SSA - Reporting a Change That May Affect Your Extra Help

IC 187637 under ICR 201108-0960-004 · OMB 0960-0723.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0723 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1026-SCE SSA - Reporting a Change That May Affect Your Extra Help	Form and Instruction
SSA-1026-SCE SSA - Reporting a Change That May Affect Your Extra Help SSA-1026-SCE Revised.pdf	Form and Instruction
SSA-1026-SCE.pdf Current SSA-1026 SCE	IC Document

IC Title:

SSA - Reporting a Change That May Affect Your Extra Help

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 418.3125

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 and Instruction	SSA-1026-SCE	SSA - Reporting a Change That May Affect Your Extra Help	SSA-1026-SCE Revised.pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,400

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11,400	-584	11,984
Annual IC Time Burden (Hours)	3,420	-175	3,595
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-1026 SCE	SSA-1026-SCE.pdf	10/12/2011

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