Information Collection

Employee Identification Statement

IC 9363 under ICR 200109-0960-003 · OMB 0960-0473.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0473 can be found here:

Documents and Forms

Document Name Document Type

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Information Collection (IC) Details

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IC Title:	Employee Identification Statement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4156				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,750	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,750	4,750
Annual IC Time Burden (Hours)	792	792
Annual IC Cost Burden (Dollars)	1,000	1,000

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.