OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Work History Report (EDCS)

IC 181136 under ICR 202508-0960-004 · OMB 0960-0578.

Documents and Forms
Document Name
Document Type
Other-SSA-3369 EDCS Screenshots -
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Work History Report (EDCS)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1565 20 CFR 404.1512 20 CFR 416.960 20 CFR 416.965 20 CFR 404.1560 20 CFR 416.912

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-SSA-3369 EDCS Screenshots - SSA-3369 EDCS Screenshots - Current Version (showing revsision for PRW FR).docx Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

38,049 0
   
Individuals or Households
 
   100 %

  Requested 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 38,049 0 0 0 0 38,049
Annual IC Time Burden (Hours) 109,074 0 0 36,781 0 72,293
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3369 - Previous Version (prior to implementation of the FR) SSA-3369 - Previous Version (prior to implementation of the FR).pdf 08/19/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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