Information Collection

SSA-8240 (paper)

IC 225979 under ICR 202003-0960-004 · OMB 0960-0807.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0807 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8420 SSA-8240 (paper)	Form
Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
SSA-8420 Authorization for the Social Security Administration to SSA-8240 - Revised.pdf	Form
SSA-8240 - Current.pdf SSA-8240 - Current	IC Document

IC Title:

SSA-8240 (paper)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form	SSA-8420	Authorization for the Social Security Administration to Obtain Wage and Employment Information from Payroll Data Providers	SSA-8240 - Revised.pdf		Yes	No	Fillable Printable
Other-Revised PA & PRA Statements			Revised PA & PRA Statements.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: 150,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150,000	13,850	136,150
Annual IC Time Burden (Hours)	15,000	1,385	13,615
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-8240 - Current	SSA-8240 - Current.pdf	07/31/2020

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