Information Collection

Request for Social Security Statement - Internet Version

IC 180317 under ICR 201002-0960-005 · OMB 0960-0466.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0466 can be found here:

Documents and Forms

Document Name Document Type
Internet Screens for SSA-7004 - Revised.pdf www.ssa.gov/mystatement/ Other-Internet Screens & Instrructio
Internet Screens for SSA-7004 - Current.pdf Current Internet Screens for SSA-7004 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Social Security Statement - Internet Version	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens & Instrruction			Internet Screens for SSA-7004 - Revised.pdf	http://www.ssa.gov/mystatement/	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 426,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	426,000	74,332	351,668
Annual IC Time Burden (Hours)	35,500	6,194	29,306
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current Internet Screens for SSA-7004	Internet Screens for SSA-7004 - Current.pdf	03/26/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.