Information Collection

SSA-8240 (Paper Version)

IC 225979 under ICR 202309-0960-002 · OMB 0960-0807.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0807 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PA Statement 0960-0807 (Revised).docx www.ssa.gov	Other-Revised PA Statement
PA Statement 0960-0807 (Revised).docx www.ssa.gov	Other-Revised PA Statement
SSA-8240 Authorization for the Social Security Administration to ssa-8240.pdf www.ssa.gov	Form
SSA-8240 Authorization for the Social Security Administration to ssa-8240.pdf www.ssa.gov	Form
ssa-8240 (Current).pdf SSA-8240 - Current	IC Document
ssa-8240 (Current).pdf SSA-8240 - Current	IC Document

IC Title:

SSA-8240 (Paper Version)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Other-Revised PA Statement			PA Statement 0960-0807 (Revised).docx	www.ssa.gov	Yes	No	Fillable Printable
Form	SSA-8240	Authorization for the Social Security Administration to Obtain Wage and Employment Information from Payroll Data Providers	ssa-8240.pdf	www.ssa.gov	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: 150,000

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	150,000	0	150,000
Annual IC Time Burden (Hours)	37,500	22,500	15,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-8240 - Current	ssa-8240 (Current).pdf	10/06/2023

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