Information Collection

Supplemental Security Income Mobile Wage Reporting (SSIMWR)

IC 203908 under ICR 201602-0960-006 · OMB 0960-0715.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0715 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSIMWR full Screens (revised).pdf	Other-Smart-Phone Application
SSIMWR (current screens).pdf SSIMWR Screens (current)	IC Document

IC Title:

Supplemental Security Income Mobile Wage Reporting (SSIMWR)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.701-732

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
Other-Smart-Phone Application			SSIMWR full Screens (revised).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: 3,083

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	36,996	-467,004	444,000	60,000
Annual IC Time Burden (Hours)	1,850	-23,350	22,200	3,000
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSIMWR Screens (current)	SSIMWR (current screens).pdf	09/29/2015

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