OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Statement of Self-Employment Income

IC 43691 under ICR 202411-0960-014 · OMB 0960-0046.

Documents and Forms
Document Name
Document Type
Form
Other-Revised Paperwork Reduction Ac
Other-Revised Paperwork Reduction Ac
Other-Revised Privacy Act
Other-Revised Privacy Act
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Statement of Self-Employment Income
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.610 20 CFR 404.110 20 CFR 404.1096 20 CFR 404.611 20 CFR 404.101 20 CFR 422.405

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-766 Statement of Self-Employment Income SSA-766.(revised) PRA PA statement Signature removal Perjury.pdf Yes No Fillable Printable
Other-Revised Paperwork Reduction Act PRA 0046 (revised).docx Yes No Printable Only
Other-Revised Privacy Act PA Statement 0046 (revised).docx Yes No Printable Only

Income Security General Retirement and Disability

 

910 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 910 0 0 0 0 910
Annual IC Time Burden (Hours) 76 0 0 0 0 76
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Statement of Self-Employment Income SSA-766 (current).pdf 11/27/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.