Information Collection

Reporting Changes That Affect Your Social Security Payment 20 CFR 404, Subparts D & E

IC 9021 under ICR 201305-0960-011 · OMB 0960-0073.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1425 Reporting Changes That Affect Your Social Security Payment 20 CFR 404, Subparts D & E	Form and Instruction
SSA-1425 REPORTING CHANGES THAT AFFECT YOUR SOCIAL SECURITY PAYME SSA-1425 (revised).pdf	Form and Instruction
SSA-1425 (current).pdf SSA-1425 (current)	IC Document

IC Title:

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 404.335-341 20 CFR 404.301-305 20 CFR 404.330-333 20 CFR 404.350 20 CFR 404.468 20 CFR 404.310-311

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-1425	REPORTING CHANGES THAT AFFECT YOUR SOCIAL SECURITY PAYMENT	SSA-1425 (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: 70,000

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	70,000	70,000
Annual IC Time Burden (Hours)	5,833	5,833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1425 (current)	SSA-1425 (current).pdf	05/28/2013

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