Statement of Self-Employment Income

Statement of Self-Employment Income

OMB: 0960-0046

IC ID: 43691

Information Collection (IC) Details

View Information Collection (IC)

Statement of Self-Employment Income
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.610 20 CFR 404.110 20 CFR 404.1096 20 CFR 404.611 20 CFR 404.101 20 CFR 422.405

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-766 Statement of Self-Employment Income SSA-766.(revised).pdf www.ssa.gov No   Fillable Printable
Other-Revised Privacy Act Statement PA Statement 0046 (revised).docx No   Printable Only
Other-Paperwork Reduction Act (revised) PRA 0046 (revised).docx No   Paper Only

Income Security General Retirement and Disability

 

910 0
   
Individuals or Households
 
   0 %

  Requested 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 910 0 0 -1,590 0 2,500
Annual IC Time Burden (Hours) 76 0 0 -132 0 208
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-766 Current Version SSA-766 (current).pdf 09/30/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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