Ssa-4659

Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook

Documents and Forms

Document Name Document Type
Form SSA-4659 SSA-4659 Form
SSA-4659 Stewardship Annual Earnings Test Workbook SSA-4659.pdf Form
0960-0189 - Updated PA and PRA Statements.pdf Other-Revised Privacy Act and PRA Statements
SSA-4659 - Current Version.pdf Current SSA-4659 IC Document

Information Collection (IC) Details

IC Title:	SSA-4659	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4659	Stewardship Annual Earnings Test Workbook	SSA-4659.pdf		No		Fillable Fileable
Other-Revised Privacy Act and PRA Statements			0960-0189 - Updated PA and PRA Statements.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 325	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	325	0	325
Annual IC Time Burden (Hours)	1,029	883	146
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-4659	SSA-4659 - Current Version.pdf	06/27/2025

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