Information Collection

Ssa-1002

IC 8936 under ICR 202410-0960-001 · OMB 0960-0036.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1002 SSA-1002	Form
Form SSA-1002 Statement of Agricultural Employer (Years Prior to 1988) SSA-1002	Form
SSA-1002 Statement of Agricultural Employer (Years Prior to 1988) SSA-1002 Revised.pdf	Form
SSA-1002 Statement of Agricultural Employer (Years Prior to 1988) SSA-1002 Revised.pdf	Form
SSA-1002 Current.pdf Statement of Agricultural Employer (Years Prior to 1988; 1988 and Later)	IC Document
SSA-1002 Current.pdf Statement of Agricultural Employer (Years Prior to 1988; 1988 and Later)	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 404.802 20 CFR 404.702 20 CFR 404.1056

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-1002				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: 7,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Farms, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	7,500	7,500
Annual IC Time Burden (Hours)	10,500	10,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Statement of Agricultural Employer (Years Prior to 1988; 1988 and Later)		10/18/2024

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

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