Ssa-l9779

Annual Earnings Test Direct Mail Follow-up Program Notices

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0369 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-L9779 SSA-L9779 Form and Instruction
SSA-L9779 Retirement, Survivors and Disability Insurance: Earnings SSA-L9779-SM-SUP - Revised Version.pdf Form and Instruction
SSA-L9779-SM-SUP.pdf Current Version of the SSA-L9779 IC Document

Information Collection (IC) Details

IC Title:	SSA-L9779	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.452-404.455

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-L9779	Retirement, Survivors and Disability Insurance: Earnings Estimate Form	SSA-L9779-SM-SUP - Revised Version.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: 158,865	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	158,865	158,865
Annual IC Time Burden (Hours)	26,478	26,478
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current Version of the SSA-L9779	SSA-L9779-SM-SUP.pdf	03/07/2011

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