Information Collection

Request for Social Security Statement--paper version

IC 9352 under ICR 201203-0960-002 · OMB 0960-0466.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0466 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7004 Request for Social Security Statement--paper version	Form
SSA-7004 Request for Social Security Statement (paper version) SSA-7004 (revised).pdf	Form
SSA-7004 Draft.pdf Current SSA-7004	IC Document

IC Title:

Request for Social Security Statement--paper version

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810

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	SSA-7004	Request for Social Security Statement (paper version)	SSA-7004 (revised).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: 127,000

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	Previously Approved
Annual Number of Responses for this IC	127,000	127,000
Annual IC Time Burden (Hours)	10,583	10,583
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-7004	SSA-7004 Draft.pdf	03/19/2012

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