Information Collection

Statement Regarding Contributions

IC 8915 under ICR 200807-0960-002 · OMB 0960-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0020 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-783 Statement Regarding Contributions Form and Instruction
SSA-783 Statement Regarding Contributions 0960-0020 (Form SSA-783).pdf PDF also available Form and Instruction
0960-0020 revised PRA statement(1).doc 0960-0020 Revised PRA Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement Regarding Contributions	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 404.376 20 CFR 404.360-.366

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-783	Statement Regarding Contributions	0960-0020 (Form SSA-783).pdf	PDF also available	No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	8,500	8,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0960-0020 Revised PRA Statement	0960-0020 revised PRA statement(1).doc	07/23/2008

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