Information Collection

Ssa-1003

IC 182041 under ICR 201310-0960-002 · OMB 0960-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1003 SSA-1003	Form
SSA-1003 Statement of Agricultural Employer for Years 1988 and La SSA-1003-F3 (Revised).pdf	Form
SSA-1003-F3 (Revised).pdf SSA-1003 (current)	IC Document

IC Title:

SSA-1003

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 404.702 20 CFR 404.1056 20 CFR 404.802

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-1003	Statement of Agricultural Employer for Years 1988 and Later	SSA-1003-F3 (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: 25,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Farms, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	25,000	25,000
Annual IC Time Burden (Hours)	12,500	12,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1003 (current)	SSA-1003-F3 (Revised).pdf	11/14/2013

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