Credit Card Payment Form

OMB 0960-0648

SSA uses Form SSA-1414 to process: (1) Credit card payments from former employees and vendors who have outstanding debts owed to the agency; (2) advance payments for reimbursable agreements; and (3) credit card payment for all Freedom of Information Act (FOIA) requests requiring payment. The respondents are former employees, and vendors who have outstanding debts to the agency; entities who have reimbursable agreements with SSA; and individuals who request information through FOIA.

The latest form for Credit Card Payment Form expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-1414 Credit Card Payment Form Form
Addendum - 0648.docx Supplementary Document
Supporting Statement - 0648 (Final).docx Supporting Statement A
Credit Card Payment Form Form

All Historical Document Collections

202111-0960-005 Approved with change	Revision of a currently approved collection	2021-11-19
201807-0960-002 Approved with change	Revision of a currently approved collection	2018-10-15
201505-0960-007 Approved without change	Reinstatement without change of a previously approved collection	2015-07-31
201402-0960-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2014-03-04
201109-0960-003 Approved without change	Revision of a currently approved collection	2012-01-13
200810-0960-012 Approved without change	Extension without change of a currently approved collection	2009-01-30
200511-0960-003 Approved with change	Extension without change of a currently approved collection	2005-11-17
200205-0960-001 Approved without change	New collection (Request for a new OMB Control Number)	2002-05-01