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Individuals or Households
Employment Relationship Questionnaire
OMB: 0960-0040
IC ID: 8948
OMB.report
SSA
OMB 0960-0040
ICR 201804-0960-006
IC 8948
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0040 can be found here:
2024-04-26 - No material or nonsubstantive change to a currently approved collection
2021-09-30 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form SSA-7160-F4
Individuals or Households
Form
Revised PA Statement.pdf
Other-Revised PA Statement
SSA-7160-F4 Employment Relationship Questionnaire
SSA-7160 - Revised.pdf
Form
SSA-7160 - Current.pdf
SSA-7160 - Current
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Individuals or Households
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 404.1007
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-7160-F4
Employment Relationship Questionnaire
SSA-7160 - Revised.pdf
Yes
No
Fillable Printable
Other-Revised PA Statement
Revised PA Statement.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
8,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
8,000
0
0
0
0
8,000
Annual IC Time Burden (Hours)
3,333
0
0
0
0
3,333
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA-7160 - Current
SSA-7160 - Current.pdf
07/24/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.