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Modified Benefit Formula Questionnaire-Employer

IC 9371 under ICR 202004-0960-003 · OMB 0960-0477.

Documents and Forms
Document Name
Document Type
Form
Other-Privacy Act Statement (revised
Other-Privacy Act Statement (revised
Other-Paperwork Reduction Act Statem
Other-Paperwork Reduction Act Statem
Form
Form
IC Document
IC Document
Information Collection (IC) Details

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Modified Benefit Formula Questionnaire-Employer
 
No Modified
 
Voluntary
 
20 CFR 404.1512-404.1515 20 CFR 416.912-416.915

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-58 Modified Benefit Formula Questionnaire-Employer SSA-58 (revised).pdf No   Fillable Printable
Other-Privacy Act Statement (revised) Privacy Act Statement 0477.doc No   Paper Only
Other-Paperwork Reduction Act Statement Revised PRA 0477.doc No   Paper Only

Income Security General Retirement and Disability

 

26,925 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 26,925 0 0 -3,075 0 30,000
Annual IC Time Burden (Hours) 4,488 0 3,142 -8,654 0 10,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-58 (current) SSA-58 (current).pdf 08/03/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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