View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0960-0046	ICR Reference No: 202107-0960-010
Status: Historical Active	Previous ICR Reference No: 201805-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement of Self-Employment Income
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: 11/30/2023
	Date Received in OIRA: 09/30/2021
Terms of Clearance: The agency modified the supporting statement to provide additional clarity regarding how the information is collected and submitted.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	36 Months From Approved	11/30/2023
Responses	910	0	2,500
Time Burden (Hours)	76	0	208
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	910	2,500	-1,590
Annual Time Burden (Hours)	76	208	-132
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: When we last cleared this IC, the burden was 208 hours. However, we are currently reporting a burden of 76 hours. This change stems from a decrease in the number of responses from 2500 to 910. The decrease stems from a decrease in the number of respondents applying for Self-Employment Income. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.

Annual Cost to Federal Government: $14,968

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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