Information Collection

SSA-1026-SCE - Reporting a Change That May Affect Your Extra Help

IC 187637 under ICR 201707-0960-003 · OMB 0960-0723.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0723 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1026-SCE SSA-1026-SCE - Reporting a Change That May Affect Your Extra Help Form and Instruction
Revised PA Statement.pdf Other-Revised PA Statement
SSA-1026-SCE SSA - Reporting a Change That May Affect Your Extra Help SSA-1026-SCE - Revised.pdf Form and Instruction
SSA-1026-SCE - Current.pdf SSA-1026-SCE - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-1026-SCE - Reporting a Change That May Affect Your Extra Help	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 418.3125

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1026-SCE	SSA - Reporting a Change That May Affect Your Extra Help	SSA-1026-SCE - Revised.pdf		No		Fillable Printable
Other-Revised PA Statement			Revised PA Statement.pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,267	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,267	-955	5,222
Annual IC Time Burden (Hours)	1,280	-287	1,567
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-1026-SCE - Current	SSA-1026-SCE - Current.pdf	09/27/2017

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