Statement of Self-Employment Income

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-766 Statement of Self-Employment Income	Form	Modified	Available
Form SSA-766 Statement of Self-Employment Income	Form	Modified	Available
Justification for the Non-Substantive Changes.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-11-27	Available
Justification for the Non-Substantive Changes.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-11-27	Repair queued
Supporting Statement - 0046 (Final).docx	Supporting Statement A	Uploaded 2023-09-27	Repair queued
Supporting Statement - 0046 (Final).docx	Supporting Statement A	Uploaded 2023-09-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43691	Statement of Self-Employment Income	Form	Modified	Statement of Self-Employment Income
43691	Statement of Self-Employment Income	Form	Modified
43691	Statement of Self-Employment Income	Other-Revised Paperwork Reduction Act	Modified

ICR Details

OMB Control No: 0960-0046	ICR Reference No: 202411-0960-014
Status: Active	Previous ICR Reference No: 202107-0960-010
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement of Self-Employment Income
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/05/2024
Terms of Clearance: In accordance with 5 CFR 1320, this information collection is approved.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	11/30/2026	11/30/2026
Responses	910	0	910
Time Burden (Hours)	76	0	76
Cost Burden (Dollars)	0	0	0

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Abstract: To qualify for insured status, and collect Social Security benefits, self employed individuals must demonstrate they earned the minimum amount of self employment income (SEI) in a current year. SSA uses Form SSA-766, Statement of Self-Employment Income, to collect the information we need to determine if the individual earned at least the minimum amount of SEI needed for one or more quarters of coverage in the current year. Based on the information we obtain, we may credit additional quarters of coverage to give the individual insured status, expediting benefit payments. Respondents are self-employed individuals potentially eligible for Social Security benefits. We are submitting this non-substantive change request to remove the signature requirement and update the Paperwork Reduction Act language.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Evidence, procedure, and certification for payments
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 40221	07/27/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 54007	09/29/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Statement of Self-Employment Income	SSA-766	Statement of Self-Employment Income

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	910	910	0	0	0	0
Annual Time Burden (Hours)	76	76	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $14,968

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/05/2024

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