Information Collection

Request for Social Security Statement--Paper Version

IC 9352 under ICR 202206-0960-001 · OMB 0960-0466.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0466 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7004 Request for Social Security Statement--Paper Version	Form
Form SSA-7004 Request for Social Security Statement (paper version) Request for Social Security Statement--Paper Version	Form
SSA-7004 Request for Social Security Statement (paper version) SSA-7004 - Revised.pdf	Form
SSA-7004 Request for Social Security Statement (paper version) SSA-7004 - Revised.pdf	Form
SSA-7004 - Current.pdf SSA-7004 - Current	IC Document
SSA-7004 - Current.pdf SSA-7004 - Current	IC Document

IC Title:

Request for Social Security Statement--Paper Version

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7004				Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32,936

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	32,936	-27,090	60,026
Annual IC Time Burden (Hours)	2,745	-2,257	5,002
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-7004 - Current		08/30/2022

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

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