Information Collection

Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits

IC 194025 under ICR 201402-1545-027 · OMB 1545-2187.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2187 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 8955-SSA Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits	Form
Form 8955-SSA Instruction.pdf	Instruction
8955-SSA Annual Registration Statement Identifying Separated Part Form 8955-SSA.pdf	Form
brdn_spec2014.pdf 2014 Burden	IC Document

IC Title:

Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	8955-SSA	Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits	Form 8955-SSA.pdf		Yes	Yes	Fillable Fileable
Instruction			Form 8955-SSA Instruction.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	200,000	200,000
Annual IC Time Burden (Hours)	166,000	166,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2014 Burden	brdn_spec2014.pdf	02/19/2014

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