Information Collection

Request for Social Security Earnings Information

IC 9428 under ICR 201703-0960-011 · OMB 0960-0525.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0525 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7050-F4 Request for Social Security Earnings Information	Form
SSA-7050-F4 Request fo Social Security Earning Information SSA-7050-F4 - Revised.pdf	Form
SSA-7050 - Current Version.pdf Current SSA-7050-F4	IC Document

IC Title:

Request for Social Security Earnings Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810 20 CFR 401.100

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-7050-F4	Request fo Social Security Earning Information	SSA-7050-F4 - Revised.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 66,800

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	66,800	0	66,800
Annual IC Time Burden (Hours)	12,247	0	12,247
Annual IC Cost Burden (Dollars)	3,812,761	3,812,761	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-7050-F4	SSA-7050 - Current Version.pdf	06/12/2017

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