Information Collection

Reporting Changes That Affect Your Social Security Payment 20 CFR 404, Subparts D & E

IC 9021 under ICR 201209-0960-005 · OMB 0960-0073.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0073 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1425 Reporting Changes That Affect Your Social Security Payment 20 CFR 404, Subparts D & E Form and Instruction
SSA-1425 REPORTING CHANGES THAT AFFECT YOUR SOCIAL SECURITY PAYME SSA-1425 (revised).pdf Form and Instruction
SSA-1425 (current).pdf SSA-1425 (current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reporting Changes That Affect Your Social Security Payment 20 CFR 404, Subparts D & E	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 404.330-333 20 CFR 404.335-341 20 CFR 404.301-305 20 CFR 404.350 20 CFR 404.468 20 CFR 404.310-311

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1425	REPORTING CHANGES THAT AFFECT YOUR SOCIAL SECURITY PAYMENT	SSA-1425 (revised).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: 70,000	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	70,000	70,000
Annual IC Time Burden (Hours)	5,833	5,833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-1425 (current)	SSA-1425 (current).pdf	09/25/2012

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