Information Collection

Request for Social Security Statement--Paper Version

IC 9352 under ICR 202601-0960-005 · OMB 0960-0466.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7004 Request for Social Security Statement (Paper Version) Request for Social Security Statement--Paper Version	Form
Revised PA Statement - SSA-7004.docx	Other-Revised PA Statement
SSA-7004 Request for Social Security Statement (Paper Version) ssa-7004 - Revised.pdf	Form
ssa-7004 - Current.pdf SSA-7004	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810

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
Form	SSA-7004				Yes	No	Fillable Printable
Other-Revised PA Statement					No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 21,155

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21,155	-11,781	32,936
Annual IC Time Burden (Hours)	2,468	-277	2,745
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-7004		04/24/2026

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

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