Modified Benefit Formula Questionnaire-Employer

Modified Benefit Formula Questionnaire-Employer

OMB: 0960-0477

IC ID: 9371

Information Collection (IC) Details

View Information Collection (IC)

Modified Benefit Formula Questionnaire-Employer
 
No Modified
 
Voluntary
 
20 CFR 416.912-416.915 20 CFR 404.1512-404.1515

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-58 Modified Benefit Formula Questionnaire-Employer SSA-58 (revised).pdf No   Paper Only

Income Security General Retirement and Disability

 

30,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30,000 0 0 0 0 30,000
Annual IC Time Burden (Hours) 10,000 0 0 0 0 10,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-58 (current) SSA-58 (current).pdf 12/23/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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