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Federal forms, ICRs, and supporting documents

Information Collection Request

Statement of Self-Employment Income, 20 CFR 404.101, 404-110, 404.1096(a)-(d)

ICR 200310-0960-004 · OMB 0960-0046 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
8957 Statement of Self-Employment Income, 20 CFR 404.101, 404-110, 404.1096(a)-(d) Form Migrated
ICR Details
0960-0046 200310-0960-004
Historical Active 200008-0960-001
SSA
Statement of Self-Employment Income, 20 CFR 404.101, 404-110, 404.1096(a)-(d)
Extension without change of a currently approved collection   No
Regular
Approved without change 11/18/2003
Retrieve Notice of Action (NOA) 10/10/2003
  Inventory as of this Action Requested Previously Approved
11/30/2006 11/30/2006 11/30/2003
5,000 0 5,000
417 0 417
0 0 0
SSA uses the information on Form SSA-766 to expedite the payment of benefits to an individual who is self-employed and who is establishing insured status in the current year. The respondents are self-employed persons.
None
None
No
1
IC Title Form No. Form Name
Statement of Self-Employment Income, 20 CFR 404.101, 404-110, 404.1096(a)-(d) SSA-766
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,000 5,000 0 0 0 0
Annual Time Burden (Hours) 417 417 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/10/2003