SSA-L2765, Request for Self-Employment Information, SSA-L3365, Request for Employee Information, SSA-L4002, Request for Employer Information

The purpose of the collection relates to the application for benefits. SSA adds the reported earnings to the respondent’s Social Security record, thereby providing the necessary earnings information to establish the correct benefit amounts that the beneficiary is due. The collection is voluntary, the modality is paper, and respondents can complete the forms by themselves. SSA employees collect and process these forms for annual use. The respondents are individuals, or the employers of those individuals; we use employer addresses only when we do not have the individual’s correct address information.

The latest form for SSA-L2765, Request for Self-Employment Information, SSA-L3365, Request for Employee Information, SSA-L4002, Request for Employer Information expires 2028-07-31 and can be found here.

SSA-L2765, Request for Self-Employment Information

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.