Information Collection

Self-Employment/Corporate Officer Work and Earnings Monitoring

IC 195407 under ICR 202403-3220-004 · OMB 3220-0202.

Documents and Forms

Document Name Document Type
Form G-252 (04-17) Self-Employment/Corporate Officer Work and Earnings Monitoring Form
G-252 (04-17) Self-Employment/Corporate Officer Work and Earnings Moni Form G-252 (04-17).pdf Form
G-252 (04-17) Self-Employment/Corporate Officer Work and Earnings Moni Form G-252 (04-17).pdf Form
Form RL-252 (04-11).pdf RL-252 - G-252 Transmittal Letter IC Document
Form RL-252 (04-11).pdf RL-252 - G-252 Transmittal Letter IC Document
Form SSA-820-BK.pdf Form SSA-820-BK IC Document
Form SSA-820-BK.pdf Form SSA-820-BK IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Self-Employment/Corporate Officer Work and Earnings Monitoring	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 216 20 CFR 220.17 -220.20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	G-252 (04-17)	Self-Employment/Corporate Officer Work and Earnings Monitoring	Form G-252 (04-17).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System	FR Citation: 79 FR 58874

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15	-85	100
Annual IC Time Burden (Hours)	5	-28	33
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
RL-252 - G-252 Transmittal Letter	Form RL-252 (04-11).pdf	04/16/2014
Form SSA-820-BK	Form SSA-820-BK.pdf	03/19/2024

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