Information Collection

Social Security Statement Evaluation Survey

IC 239765 under ICR 201810-0960-002 · OMB 0960-0526.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0526 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Social Security Statement Evaluation Survey.pdf	Other-Social Security Statement Eval
Description of Social Security Statement Evaluation Survey.docx Description of Social Security Statement Evaluation Survey	IC Document

IC Title:

Social Security Statement Evaluation Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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
Other-Social Security Statement Evaluation Survey			Social Security Statement Evaluation Survey.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,400	1,400
Annual IC Time Burden (Hours)	700	700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Description of Social Security Statement Evaluation Survey	Description of Social Security Statement Evaluation Survey.docx	02/05/2020

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