Information Collection

Ssa-1002

IC 8936 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-1002 (revised) SSA-1002 Form
SSA-1002 (revised) Statement of Agricultural Employer (Years Prior to 1988) SSA-1002-F3 (Revised).pdf Form
ssa-1002-F3 (current).pdf SSA-1002 (current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-1002	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 404.802 20 CFR 404.1056 20 CFR 404.702

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1002 (revised)	Statement of Agricultural Employer (Years Prior to 1988)	SSA-1002-F3 (Revised).pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,500	7,500
Annual IC Time Burden (Hours)	3,750	3,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-1002 (current)	ssa-1002-F3 (current).pdf	11/14/2013

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