Information Collection

SSA-8240 (paper)

IC 225979 under ICR 201709-0960-002 · OMB 0960-0807.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0807 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8420 SSA-8240 (paper)	Form
SSA-8420 Authorization for the Social Security Administration to SSA-8240 - Fillable Version.pdf	Form
Authorization Form SSA-8240 (curernt).pdf SSA-8420 (current)	IC Document

IC Title:

SSA-8240 (paper)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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-8420	Authorization for the Social Security Administration to Obtain Wage and Employment Information from Payroll Data Providers	SSA-8240 - Fillable Version.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: 136,150

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	136,150	136,150
Annual IC Time Burden (Hours)	13,615	13,615
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-8420 (current)	Authorization Form SSA-8240 (curernt).pdf	09/07/2017

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