Request for Social Security Statement--Paper Version

Request for Social Security Statement

Documents and Forms

Document Name Document Type
Form SSA-7004 Request for Social Security Statement--Paper Version Form
SSA-7004 Request for Social Security Statement (paper version) SSA-7004 - Revised.pdf Form
SSA-7004 Request for Social Security Statement (paper version) SSA-7004 - Revised.pdf Form
SSA-7004 - Current.pdf SSA-7004 - Current IC Document
SSA-7004 - Current.pdf SSA-7004 - Current IC Document

Information Collection (IC) Details

IC Title:	Request for Social Security Statement--Paper Version	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.810

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7004	Request for Social Security Statement (paper version)	SSA-7004 - Revised.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 32,936	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	32,936	-27,090	60,026
Annual IC Time Burden (Hours)	2,745	-2,257	5,002
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-7004 - Current	SSA-7004 - Current.pdf	08/30/2022

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