Information Collection

Request for Social Security Earnings Information

IC 9428 under ICR 202609-0960-001 · OMB 0960-0525.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7050 Request fo Social Security Earning Information Request for Social Security Earnings Information	Form
Privacy Act Statement - Revised.docx	Other-Revised PA Statement
SSA-7050 Request fo Social Security Earning Information SSA-7050 - Revised.docx	Form
ssa-7050 - Current.pdf SSA 7050 - Current	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 20 CFR 401.100

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-7050				Yes	No	Fillable Printable
Other-Revised PA Statement					Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 66,800

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	66,800	0	66,800
Annual IC Time Burden (Hours)	12,247	0	12,247
Annual IC Cost Burden (Dollars)	3,649,017	-3,498,583	7,147,600

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA 7050 - Current		09/27/2026

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].