OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

HA-4633 - Paper Version

IC 9205 under ICR 202508-0960-003 · OMB 0960-0300.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

HA-4633 - Paper Version
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1565(b) 20 CFR 416.912(a) 20 CFR 404.1520(a)(4) 20 CFR 416.920(a)(4) 20 CFR 404.1512(a) 20 CFR 416.965(b)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HA-4633 Claimant's Work Background HA-4633 - Revised Version.pdf www.ssa.gov (mySocial Security Account - Upload Documents) No   Fillable Fileable Signable

Income Security General Retirement and Disability

 

48,450 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 48,450 0 0 16,150 0 32,300
Annual IC Time Burden (Hours) 16,150 0 0 0 0 16,150
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HA-4633 - Prior to Implementation of the PRW Rule HA-4633 (Prior to PRW Rule).pdf 03/11/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].