Information Collection

Ssa-1002

IC 8936 under ICR 202008-0960-008 · OMB 0960-0036.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1002 SSA-1002	Form
Updated PA Statement.pdf	Other-Revised PA Statement
0036 PRA Statement.docx	Other-Paperwork Reduction Act Statem
SSA-1002 Statement of Agricultural Employer (Years Prior to 1988) SSA-1002(revised).pdf	Form
SSA-1002 (Current).pdf SSA-1002	IC Document

IC Title:

SSA-1002

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 404.702 20 CFR 404.1056 20 CFR 404.802

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1002	Statement of Agricultural Employer (Years Prior to 1988)	SSA-1002(revised).pdf	Yes	No	Fillable Printable
Other-Revised PA Statement			Updated PA Statement.pdf	Yes	No	Fillable Printable
Other-Paperwork Reduction Act Statement 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: 7,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	7,500	7,500
Annual IC Time Burden (Hours)	3,750	3,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1002	SSA-1002 (Current).pdf	08/19/2020

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