Information Collection

Private Sector

IC 45415 under ICR 200609-0960-013 · OMB 0960-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7160-F4 Employment Relationship Questionnaire Private Sector	Form
SSA-7160-F4 Employment Relationship Questionnaire SSA-7160-F4.pdf	Form

IC Title:

Private Sector

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1007

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7160-F4				No		Paper Only

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions, Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	7,200	7,200
Annual IC Time Burden (Hours)	3,000	3,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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