Information Collection

Work History Report (EDCS)

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-3369 EDCS Screenshots - Current Version (showing revsision for PRW FR).docx	Other-SSA-3369 EDCS Screenshots -
SSA-3369 - Previous Version (prior to implementation of the FR).pdf SSA-3369 - Previous Version (prior to implementation of the FR)	IC Document

IC Title:

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 404.1565 20 CFR 404.1512 20 CFR 416.960 20 CFR 416.965 20 CFR 404.1560 20 CFR 416.912

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
Other-SSA-3369 EDCS Screenshots -					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: 38,049

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	38,049	0	38,049
Annual IC Time Burden (Hours)	109,074	36,781	72,293
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-3369 - Previous Version (prior to implementation of the FR)		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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