Information Collection

Employee Work Activity Questionnaire

IC 9380 under ICR 201407-0960-012 · OMB 0960-0483.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0483 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-3033 Employee Work Activity Questionnaire Form and Instruction
SSA-3033 Work Activity Questionnaire SSA-3033 (revised).pdf Form and Instruction
SSA-3033 (current).pdf SSA-3033(current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Employee Work Activity Questionnaire	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 404.1574(a)(1)-(3)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-3033	Work Activity Questionnaire	SSA-3033 (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: 15,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	3,750	3,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-3033(current)	SSA-3033 (current).pdf	07/22/2014

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