Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2187 can be found here:

Documents and Forms

Document Name Document Type
Form 8955-SSA Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits Form
Form 8955-SSA Instruction.pdf Instruction
8955-SSA Annual Registration Statement Identifying Separated Part Form 8955-SSA.pdf Form
brdn_spec2014.pdf 2014 Burden IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	8955-SSA	Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits	Form 8955-SSA.pdf		Yes	Yes	Fillable Fileable
Instruction			Form 8955-SSA Instruction.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	200,000	200,000
Annual IC Time Burden (Hours)	166,000	166,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2014 Burden	brdn_spec2014.pdf	02/19/2014

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