Automated Telephone Requestors SSA-1099/1042S

Internet Request for Replacement of Form SSA-1099/SSA-1042S

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0583 can be found here:

Documents and Forms

Document Name Document Type
SSA_ATT_Care2020_N8NN UI Document (5.14.15).pdf Other-Automated Telephone Requestor
Privacy Act Statement.doc Other-Privacy Act Statement 0583

Information Collection (IC) Details

IC Title:	Automated Telephone Requestors SSA-1099/1042S	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 401.45

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Automated Telephone Requestor Screens			SSA_ATT_Care2020_N8NN UI Document (5.14.15).pdf		Yes	Yes	Paper Only
Other-Privacy Act Statement 0583			Privacy Act Statement.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 238,286	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	238,286	31,862	206,424
Annual IC Time Burden (Hours)	7,943	1,062	6,881
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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