Information Collection

Request for Social Security Earnings Information

IC 9428 under ICR 201901-0960-006 · OMB 0960-0525.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0525 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7050 Request for Social Security Earnings Information	Form
Drop-down Calendar Box Example.pdf	Other-Drop-Down Example
SSA-7050 Request fo Social Security Earning Information SSA-7050 - Revised.pdf	Form
SSA-7050 - Current.pdf SSA-7050 - Current	IC Document

IC Title:

Request for Social Security Earnings Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810 20 CFR 401.100

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-7050	Request fo Social Security Earning Information	SSA-7050 - Revised.pdf		Yes	No	Fillable Printable
Other-Drop-Down Example			Drop-down Calendar Box Example.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: 66,800

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	66,800	66,800
Annual IC Time Burden (Hours)	12,247	12,247
Annual IC Cost Burden (Dollars)	3,812,761	3,812,761

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-7050 - Current	SSA-7050 - Current.pdf	01/28/2019

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