Ssa-85

Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0189 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-85 SSA-85 Form
SSA-85 - Revised PA Statement.pdf Other-Revised PA Statement
SSA-85 Information Needed to Review Your Social Security Claim SSA-85 - Revised Version.pdf Form
SSA-85 - Current Version.pdf Current SSA-85 IC Document

Information Collection (IC) Details

IC Title:	SSA-85	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-85	Information Needed to Review Your Social Security Claim	SSA-85 - Revised Version.pdf		No		Paper Only
Other-Revised PA Statement			SSA-85 - Revised PA Statement.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: 3,850	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,850	3,850
Annual IC Time Burden (Hours)	321	321
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-85	SSA-85 - Current Version.pdf	08/18/2017

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