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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.