Internet Request for Replacement SSA-1099/1042S

Internet Request for Replacement of Form SSA-1099/SSA-1042S

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0583 can be found here:

Documents and Forms

Document Name Document Type
OMB_Screen_Package screens revised.pdf Other-Internet Screens for Request f

Information Collection (IC) Details

IC Title:	Internet Request for Replacement SSA-1099/1042S	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 401.45

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens for Request for Replacement of Forms SSA-1099/SSA-1042S			OMB_Screen_Package screens revised.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 145,390	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	145,390	8,935	136,455
Annual IC Time Burden (Hours)	24,232	1,489	22,743
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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