Ssa-1003

Statement of Agricultural Employer (Year Prior to 1988; 1988 and Later)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0036 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1003 SSA-1003 Form
0036 Privacy Act Statement.docx Other-Revised PA Statement
0036 PRA Statement.docx Other-Paperwork Reduction Act revise
SSA-1003 Statement of Agricultural Employer for Years 1988 and La SSA-1003 (Revised).pdf Form
SSA-1003 (Current).pdf SSA-1003-F3 IC Document

Information Collection (IC) Details

IC Title:	SSA-1003	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 404.1056 20 CFR 404.802 20 CFR 404.702

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1003	Statement of Agricultural Employer for Years 1988 and Later	SSA-1003 (Revised).pdf	Yes	No	Fillable Printable
Other-Revised PA Statement			0036 Privacy Act Statement.docx	Yes	No	Fillable Printable
Other-Paperwork Reduction Act revised			0036 PRA Statement.docx	No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Farms, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	25,000	25,000
Annual IC Time Burden (Hours)	12,500	12,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-1003-F3	SSA-1003 (Current).pdf	08/19/2020

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