Statement Regarding Contributions

Statement Regarding Contributions

OMB: 0960-0020

IC ID: 8915

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Privacy Act Statement 0020 (re
Other-Paperwork Reduction Act Statem
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Statement Regarding Contributions
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.376 20 CFR 404.360-.404.366

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-783 Statement Regarding Contributions SSA-783 (revised).pdf PDF also available Yes No Fillable Printable
Other-Privacy Act Statement 0020 (revised) SSA-783 Privacy Act Statement (revised).doc Yes No Fillable Printable
Other-Paperwork Reduction Act Statement Revised PRA Statement (revised).doc Yes No Fillable Printable

Income Security General Retirement and Disability

 

30,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30,000 0 0 0 0 30,000
Annual IC Time Burden (Hours) 8,500 0 0 0 0 8,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-783 SSA-783 - Fillable.pdf 04/18/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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