Certification by Religious Group

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0093 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1458 Certification by Religious Group Form
PRA (revised).docx Other-Revised PRA Statements
PRA (revised).docx Other-Revised PRA Statements
SSA-1458 Certification by Religious Group SSA-1458 (revised).pdf Form
SSA-1458 Certification by Religious Group SSA-1458 (revised).pdf Form
SSA-1458 (current).pdf SSA-1458 - Current IC Document
SSA-1458 (current).pdf SSA-1458 - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification by Religious Group	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.1075

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1458	Certification by Religious Group	SSA-1458 (revised).pdf		No		Paper Only
Other-Revised PRA Statements			PRA (revised).docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 142	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	Previously Approved
Annual Number of Responses for this IC	142	-38	180
Annual IC Time Burden (Hours)	36	-9	45
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-1458 - Current	SSA-1458 (current).pdf	03/05/2021

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