Information Collection

Government Pension Questionnaire

IC 9142 under ICR 202503-0960-006 · OMB 0960-0160.

Documents and Forms

Document Name Document Type
Form SSA-3885 Government Pension Questionnaire Form
0160 MCS Screens.pdf Other-Internal Screens
0160 MCS Screens.pdf Other-Internal Screens
SSA-3885 Government Pension Questionnaire SSA-3885 (revised).pdf www.ssa.gov Form
SSA-3885 Government Pension Questionnaire SSA-3885 (revised).pdf www.ssa.gov Form
SSA-3885 (current).pdf SSA-3885 - Current Version IC Document
SSA-3885 (current).pdf SSA-3885 - Current Version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Government Pension Questionnaire	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 404.408a

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3885	Government Pension Questionnaire	SSA-3885 (revised).pdf	www.ssa.gov	No		Fillable Printable
Other-Internal Screens			0160 MCS Screens.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 32,478	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 60 %

	Approved	Previously Approved
Annual Number of Responses for this IC	32,478	32,478
Annual IC Time Burden (Hours)	36,267	36,267
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-3885 - Current Version	SSA-3885 (current).pdf	03/14/2025

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