Information Collection

IRS-SSA Spouse Reported Income

IC 249239 under ICR 202010-2900-006 · OMB 2900-0867.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0867 can be found here:

Documents and Forms

Document Name Document Type
Form 10-302 IRS-SSA Spouse Reported Income Form and Instruction
10-302 IRS-SSA Spouse Reported Income VA Form 10-302.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	IRS-SSA Spouse Reported Income	Agency IC Tracking Number:	2900-0867

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-302	IRS-SSA Spouse Reported Income	VA Form 10-302.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17,038	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17,038	17,038
Annual IC Time Burden (Hours)	5,679	5,679
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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