Ssa-1003

Statement of Agricultural Employer (Year Prior to 1988; 1988 and Later)

Documents and Forms

Document Name Document Type
Form SSA-1003 SSA-1003 Form
SSA-1003 Statement of Agricultural Employer (1988 and Later) SSA-1003 Revised.pdf Form
SSA-1003 Current.pdf Statement of Agricultural Employer (1988 and Later) IC Document

Information Collection (IC) Details

IC Title:	SSA-1003	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 404.1056 20 CFR 404.802 20 CFR 404.702

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1003	Statement of Agricultural Employer (1988 and Later)	SSA-1003 Revised.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	25,000	25,000
Annual IC Time Burden (Hours)	35,000	35,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Statement of Agricultural Employer (1988 and Later)	SSA-1003 Current.pdf	10/21/2024

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