mySSA Earnings Corrections Screen Package

Online Request for Correction of Earnings Record

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0819 can be found here:

Documents and Forms

Document Name Document Type
Proof of Earnings Modal (revised).pdf Other-mySSA Earnings Corrections Scr
mySSA Earnings Corrections Screen Package (revised).pdf Other-mySSA Earnings Corections Scre
( mySSA Earnings Corrections Screen Package (current).pdf mySSA Earnings Correction Screens IC Document

Information Collection (IC) Details

IC Title:	mySSA Earnings Corrections Screen Package	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 404.820 20 CFR 422.125

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-mySSA Earnings Corrections Screen Package			Proof of Earnings Modal (revised).pdf		Yes	Yes	Fillable Fileable Signable
Other-mySSA Earnings Corections Screens			mySSA Earnings Corrections Screen Package (revised).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: 76,047	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	76,047	76,047
Annual IC Time Burden (Hours)	19,012	19,012
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
mySSA Earnings Correction Screens	( mySSA Earnings Corrections Screen Package (current).pdf	12/17/2020

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