Supplemental Security Income Mobile Wage Reporting (SSIMWR)

Monthly SSI Wage Reporting

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0715 can be found here:

Documents and Forms

Document Name Document Type
SSIMWR (revised screens).pdf Other-Smart-Phone Application
SSIMWR (current screens).pdf SSIMWR Screens (current) IC Document

Information Collection (IC) Details

IC Title:	Supplemental Security Income Mobile Wage Reporting (SSIMWR)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.701-732

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Smart-Phone Application			SSIMWR (revised screens).pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	3,000	3,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSIMWR Screens (current)	SSIMWR (current screens).pdf	09/29/2015

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