Request for Social Security Statement

OMB 0960-0466

SSA collects information on Form SSA-7004 to identify respondents' Social Security earnings records; extract posted earnings information; calculate potential benefit estimates; produce the resulting Social Security Statements, and mail them to the requesters. Respondents are Social Security number holders requesting information about their Social Security earnings records and estimates of their potential benefits.

The latest form for Request for Social Security Statement expires 2022-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-7004 Request for Social Security Statement--Paper Version Form
Addendum - 0466.docx Supplementary Document
Supporting Statement - 0466 (Final).docx Supporting Statement A
Request for Social Security Statement--Paper Version Form

All Historical Document Collections

202206-0960-001 Approved without change	Revision of a currently approved collection	2022-10-03
201905-0960-001 Approved without change	Revision of a currently approved collection	2019-08-19
201606-0960-003 Approved without change	Revision of a currently approved collection	2016-09-02
201302-0960-002 Approved without change	Revision of a currently approved collection	2013-07-30
201203-0960-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-03-20
201002-0960-005 Approved without change	Revision of a currently approved collection	2010-07-12
200705-0960-016 Approved without change	Extension without change of a currently approved collection	2007-07-03
200405-0960-015 Approved without change	Extension without change of a currently approved collection	2004-05-27
200109-0960-013 Approved without change	No material or nonsubstantive change to a currently approved collection	2001-09-24
200103-0960-003 Approved without change	Extension without change of a currently approved collection	2001-03-26
199802-0960-006 Approved without change	Revision of a currently approved collection	1998-02-23
199704-0960-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1997-04-24
199505-0960-006 Approved without change	Revision of a currently approved collection	1995-05-22
199112-0960-004 Approved without change	Extension without change of a currently approved collection	1991-12-09
198901-0960-006 Approved without change	Extension without change of a currently approved collection	1989-01-19
198811-0960-001 Approved without change	New collection (Request for a new OMB Control Number)	1988-11-21

OMB Details

Request for Social Security Statement--paper version

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-7004

Request for Social Security Statement (paper version)

Paper Only

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.