Information Collection

Ssa-4659

IC 183268 under ICR 202502-0960-005 · OMB 0960-0189.

Documents and Forms

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

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:

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-4659				No		Fillable Fileable
Other-Revised Privacy Act and PRA Statements					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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-4659		06/27/2025

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

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