DOMESTIC SERVICE QUESTIONNAIRE

ICR 199308-0960-006

OMB: 0960-0047

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
114416 Migrated
ICR Details
0960-0047 199308-0960-006
Historical Active 199207-0960-003
SSA
DOMESTIC SERVICE QUESTIONNAIRE
Revision of a currently approved collection   No
Regular
Approved without change 11/16/1993
Retrieve Notice of Action (NOA) 08/19/1993
This information collection is approved through 5-94 under the followi condition: As agreed to by SSA, the agency will provide statistics on the percentage of individuals whose work does not qualify as "employment" under SSA regulations. This information will help inform OMB on the balance between the burden imposed by this paperwork and th improvement in accuracy of claims.
  Inventory as of this Action Requested Previously Approved
05/31/1994 05/31/1994 09/30/1993
12,000 0 20,000
6,000 0 10,000
0 0 0

THE INFORMATION IS NEEDED TO DETERMINE IF THE DOMESTIC SERVICES OF AN INDIVIDUAL PERFORMED IN THE HOME OF A SON OR DAUGHTER ARE COVERED EMPLOYMENT UNDER THE SOCIAL SECURITY ACT. THE RESPONDENTS ARE THE SONS OR DAUGHTERS WHO EMPLOY CLAIMANTS FOR BENEFITS AS DOMESTICS.

None
None


No

1
IC Title Form No. Form Name
DOMESTIC SERVICE QUESTIONNAIRE SSA-7155

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 12,000 20,000 0 0 -8,000 0
Annual Time Burden (Hours) 6,000 10,000 0 0 -4,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/19/1993


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