Information Collection

Certification by Religious Group

IC 43692 under ICR 202412-0960-009 · OMB 0960-0093.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1458 Certification by Religious Group	Form and Instruction
Form SSA-1458 Certification by Religious Group Certification by Religious Group	Form and Instruction
SSA-1458 Certification by Religious Group SSA-1458 (revised).pdf	Form and Instruction
SSA-1458 Certification by Religious Group SSA-1458 (revised).pdf	Form and Instruction
SSA-1458 (current).pdf SSA-1458 (current)	IC Document
SSA-1458 (current).pdf SSA-1458 (current)	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.1075

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 and Instruction	SSA-1458				No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 142

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	Previously Approved
Annual Number of Responses for this IC	142	142
Annual IC Time Burden (Hours)	71	71
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1458 (current)		12/20/2024

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

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