Information Collection

SSA-8240 (paper)

IC 225979 under ICR 201703-0960-002 · OMB 0960-0807.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0807 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-8420 SSA-8240 (paper) Form
SSA-8420 Authorization for the Social Security Administration to Authorization Form (013).docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-8240 (paper)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8420	Authorization for the Social Security Administration to Obtain Wage and Employment Information from Payroll Data Providers	Authorization Form (013).docx		Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 136,150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	136,150	136,150
Annual IC Time Burden (Hours)	13,615	13,615
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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