Request for Social Security Statement - Internet Version- On Hold

Request for Social Security Statement

⚠️ Notice: This information collection may be referencing outdated material.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

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

Is this a Common Form? No		IC Status: Unchanged

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: 1	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	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.