Information Collection

Government Pension Questionnaire

IC 9142 under ICR 201312-0960-014 · OMB 0960-0160.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0160 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3885 Government Pension Questionnaire	Form and Instruction
SSA-3885 - MCS Screens.pdf	Other-Internal Screens
SSA-3885 Government Pension Questionnaire SSA-3885 - Revised Version.pdf	Form and Instruction
SSA-3885 - Current Version.pdf Current SSA-3885	IC Document

IC Title:

Government Pension Questionnaire

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 404.408a

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-3885	Government Pension Questionnaire	SSA-3885 - Revised Version.pdf		No		Paper Only
Other-Internal Screens			SSA-3885 - MCS Screens.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: 76,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 60 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	76,000	0	76,000
Annual IC Time Burden (Hours)	16,467	634	15,833
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-3885	SSA-3885 - Current Version.pdf	02/10/2014

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