Information Collection

Railroad Employment Questionnaire

IC 9025 under ICR 202004-0960-004 · OMB 0960-0078.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0078 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-671 Railroad Retirement Questionnaire Railroad Employment Questionnaire	Form
MCS-MSSICS Screens.docx	Other-screens
MCS-MSSICS Screens.docx	Other-screens
0078 Privacy Act Statement (revised).pdf	Other-Revised Privacy Act Statements
0078 PRA.pdf	Other-Revised Paperwork Reduction Ac
0078 PRA.pdf	Other-Revised Paperwork Reduction Ac
SSA-671 Railroad Retirement Questionnaire SSA-671 (revised).pdf	Form
SSA-671 Railroad Retirement Questionnaire SSA-671 (revised).pdf	Form
SSA-671 (current).pdf SSA-671 Current Version	IC Document
SSA-671 (current).pdf SSA-671 Current Version	IC Document

IC Title:

Railroad Employment Questionnaire

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 404.1401 20 CFR 404.1406-.1408

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-671	Yes	No	Fillable Printable
Other-screens		Yes	Yes	Fillable Fileable Signable
Other-Revised Paperwork Reduction Act		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 125,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	125,000	0	125,000
Annual IC Time Burden (Hours)	122,917	112,500	10,417
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-671 Current Version		06/09/2020

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

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