Information Collection

Report to U.S. SSA

IC 178733 under ICR 200702-0960-004 · OMB 0960-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0049 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-7162-OCR-SM Report to U.S. SSA Form
SSA-7162-OCR-SM Report to U.S. SSA SSA-7162-OCR-SM (09-2004).pdf Form
Form SSA-7162-INST (03-2004).pdf Form SSA-7162-INSTRUCTIONS IC Document
PRA Statement.doc PRA Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report to U.S. SSA	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7162-OCR-SM	Report to U.S. SSA	SSA-7162-OCR-SM (09-2004).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: 236,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	236,500	236,500
Annual IC Time Burden (Hours)	19,708	19,708
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Form SSA-7162-INSTRUCTIONS	Form SSA-7162-INST (03-2004).pdf	05/09/2007
PRA Statement	PRA Statement.doc	05/09/2007

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