Information Collection

Statement Regarding Date of Birth and Citizenship

IC 8904 under ICR 201404-0960-012 · OMB 0960-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-702 Statement Regarding Date of Birth and Citizenship	Form
SSA-702 Statement Regarding Date of Birth and Citizenship ssa702 (revised).pdf	Form
ssa702 (current).pdf SSA-702 Current Version	IC Document

IC Title:

Statement Regarding Date of Birth and Citizenship

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 404.716

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-702	Statement Regarding Date of Birth and Citizenship	ssa702 (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: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-702 Current Version	ssa702 (current).pdf	05/09/2014

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