Information Collection

Certification by Religious Group

IC 43692 under ICR 201712-0960-001 · OMB 0960-0093.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0093 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1458 Certification by Religious Group	Form
Updated PA & PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA-1458 Certification by Religious Group SSA-1458 - Revised.pdf	Form
SSA-1458 - Current.pdf SSA-1458 - Current	IC Document

IC Title:

Certification by Religious Group

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.1075

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-1458	Certification by Religious Group	SSA-1458 - Revised.pdf		No		Paper Only
Other-Revised PA and PRA Statements			Updated PA & PRA Statements.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180

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	180	180
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1458 - Current	SSA-1458 - Current.pdf	01/17/2018

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