Information Collection

Railroad Employment Questionnaire

IC 9025 under ICR 201511-0960-006 · OMB 0960-0078.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0078 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-671 Railroad Employment Questionnaire	Form
0960-0078 MCS-MSSICS screens.doc	Other-screens
SSA-671 Railroad Retirement Questionnaire SS671LC - Fillable.pdf	Form
ssa-671(current).pdf SSA-671 Current Version	IC Document

IC Title:

Railroad Employment 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 404.1401 20 CFR 404.1406-.1408

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-671	Railroad Retirement Questionnaire	SS671LC - Fillable.pdf		Yes	No	Fillable Printable
Other-screens			0960-0078 MCS-MSSICS screens.doc		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: 125,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	125,000	125,000
Annual IC Time Burden (Hours)	10,417	10,417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-671 Current Version	ssa-671(current).pdf	11/10/2015

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