Approved for use
through 7/2003 under the condition that the next submission for OMB
review reflects SSA's progress in meeting its GPEA deadline of
October 1, 2003.
Inventory as of this Action
Requested
Previously Approved
09/30/2003
09/30/2003
08/31/2002
50,000
0
50,000
16,667
0
16,667
0
0
0
Form SSA-4184 is used by SSA to
develop earnings and corroborate a claimant's allegations regarding
retirement when the claimant is self-employed or a corporate
officer. The information collected is used to determine the benefit
amount. The respondents are self-employed individuals and corporate
officers.
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.