View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0960-0036	ICR Reference No: 202008-0960-008
Status: Historical Active	Previous ICR Reference No: 201609-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement of Agricultural Employer (Year Prior to 1988; 1988 and Later)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/01/2024
	Date Received in OIRA: 08/21/2020
Terms of Clearance: The agency made clarifications to the Supporting Statement A and updated the burden estimates. Prior to triannual renewal, the agency will allow for electronic submission of this information collection or will upload a separate document in which the agency provides a fact-specific justification for why this information collection cannot be signed and filed electronically and why this is consistent with the agency's commitments under Sec. 4 (k)(iii) and (iv) of E.O. 14058..

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved	04/30/2024
Responses	32,500	0	32,500
Time Burden (Hours)	45,500	0	16,250
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
SSA-1002	SSA-1002
SSA-1003	SSA-1003

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	32,500	32,500	0
Annual Time Burden (Hours)	45,500	16,250	29,250
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are no changes to the public reporting burden. * Note: The total burden reflected in ROCIS is 45,500, while the burden cited in #12 of the Supporting Statement is 16,250. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

Annual Cost to Federal Government: $1,776,362

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

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