OMB control number

Statement of Claimant or Other Person-Medical Resident FICA Refund Claims

OMB 0960-0786 · SSA.

OMB 0960-0786

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-795-OP2 Statement of Claimant or Other Person-Medical Resident FICA Refund Claims Form
Addendum to Supporting Statement SSA-795-OP2.docx Supporting Statement B
Supporting Statement 0786 (revised).docx Supporting Statement A
Statement of Claimant or Other Person-Medical Resident FICA Refund Claims Form

All Historical Document Collections

201107-0960-002 Approved without change	Revision of a currently approved collection	2011-10-12
201102-0960-006 Approved without change	New collection (Request for a new OMB Control Number)	2011-04-06