Information Collection

Self-Employment/Corporate Officer Work and Earnings Monitoring

IC 195407 under ICR 201704-3220-002 · OMB 3220-0202.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0202 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-252 (04-17) Self-Employment/Corporate Officer Work and Earnings Monitoring Self-Employment/Corporate Officer Work and Earnings Monitoring	Form
G-252 (04-17) Self-Employment/Corporate Officer Work and Earnings Moni Form G-252 (04-17).pdf	Form
Form RL-252 (04-11).pdf RL-252 - G-252 Transmittal Letter	IC Document
SSA-4184 (01-91).pdf SSA-4184	IC Document

IC Title:

Self-Employment/Corporate Officer Work and Earnings Monitoring

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 216 20 CFR 220.17 -220.20

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	G-252 (04-17)				No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System

FR Citation: 79 FR 58874

Number of Respondents: 100

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	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RL-252 - G-252 Transmittal Letter		04/16/2014
SSA-4184		04/16/2014

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

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