OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Work History Report

IC 9542 under ICR 202508-0960-004 · OMB 0960-0578.

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

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-3369 Work History Report SSA-3369 - Current Version (showing revisons for the PRW FR).pdf Yes No Fillable Printable

Income Security General Retirement and Disability

 

1,553,900 0
   
Individuals or Households
 
   0 %

  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 1,553,900 0 0 0 0 1,553,900
Annual IC Time Burden (Hours) 1,812,883 0 0 -1,139,527 0 2,952,410
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3369-BK -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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