Information Collection

Ssa-4659

IC 183268 under ICR 201807-0960-008 · OMB 0960-0189.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0189 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-4659 SSA-4659 Form
SSA-4659 - Revised PA Statement.pdf Other-Revised PA Statement
SSA-4659 Stewardship Annual Earnings Test Workbook SSA-4659 - Revised Version.pdf Form
SSA-4659 - Current Version.pdf Current SSA-4659 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-4659	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4659	Stewardship Annual Earnings Test Workbook	SSA-4659 - Revised Version.pdf		No		Paper Only
Other-Revised PA Statement			SSA-4659 - Revised PA Statement.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: 325	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	325	325
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-4659	SSA-4659 - Current Version.pdf	08/18/2017

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