Information Collection

Questionnaire About Employment or Self-Employment Outside the United States

IC 8964 under ICR 200701-0960-011 · OMB 0960-0050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7163 Questionnaire About Employment or Self-Employment Outside the United States	Form
SSA-7163 Questionnaire About employment or Self Employment Outsid SSA-7163.pdf	Form

IC Title:

Questionnaire About Employment or Self-Employment Outside the United States

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 404.401(b)(1) 20 CFR 404.415 20 CFR 404.417

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-7163	Questionnaire About employment or Self Employment Outside the United States	SSA-7163.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	4,000	4,000
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.