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 | Type |
|---|---|
 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201107-0960-002 | Revision of a currently approved collection | 2011-10-12 | Approved without change | |
| 201102-0960-006 | New collection (Request for a new OMB Control Number) | 2011-04-06 | Approved without change |