Ssa-l9781

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⚠️ Notice: This information collection may be referencing outdated material.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-L9781 SSA-L9781 Form and Instruction
SSA-L9781 Retirement, Survivors and Disability Insurance: Earnings 2015 SSA 9781.pdf Form and Instruction
SSA 9781 (current).pdf SSA-9781 IC Document

Information Collection (IC) Details

IC Title:	SSA-L9781	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 404.452-404.455

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-L9781	Retirement, Survivors and Disability Insurance: Earnings Estimate Form	2015 SSA 9781.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: 472,437	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	472,437	472,437
Annual IC Time Burden (Hours)	78,740	78,740
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-9781	SSA 9781 (current).pdf	06/02/2015

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