Automated Telephone Requestors SSA-1099/1042S

Internet Request for Replacement of Form SSA-1099/SSA-1042S

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0583 can be found here:

Documents and Forms

Document Name Document Type
SSA_N8NN (revised).pdf Other-Automated Telephone Requestor
SSA_N8NN (revised).pdf Other-Automated Telephone Requestor
Privacy Act Statement.doc Other-Privacy Act Statement 0583
Privacy Act Statement.doc Other-Privacy Act Statement 0583
SSA_N8NN (current).pdf SSA_N8NN (current) IC Document
SSA_N8NN (current).pdf SSA_N8NN (current) IC Document

Information Collection (IC) Details

IC Title:	Automated Telephone Requestors SSA-1099/1042S	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 401.45

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Automated Telephone Requestor Screens			SSA_N8NN (revised).pdf		Yes	Yes	Paper Only
Other-Privacy Act Statement 0583			Privacy Act Statement.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 238,286	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	238,286	0	238,286
Annual IC Time Burden (Hours)	83,400	75,457	7,943
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA_N8NN (current)	SSA_N8NN (current).pdf	02/10/2022

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