Ssa-l9785

Annual Earnings Test Direct Mail Follow-up Program Notices

Documents and Forms

Document Name Document Type
Form SSA-L9785 SSA-L9785 Form and Instruction
SSA-L9785 Retirement, Survivors and Disability Insurance: Earnings SSA-9785 - Revised Version.pdf Form and Instruction
SSA-9785 - Current Version.pdf Current SSA-9785 IC Document

Information Collection (IC) Details

IC Title:	SSA-L9785	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.452-404.455

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-L9785	Retirement, Survivors and Disability Insurance: Earnings Estimate Form	SSA-9785 - Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,870	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	15,870	15,870
Annual IC Time Burden (Hours)	2,645	2,645
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-9785	SSA-9785 - Current Version.pdf	12/08/2020

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