Information Collection

Child-Care Dropout Questionnaire

IC 9367 under ICR 200707-0960-002 · OMB 0960-0474.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0474 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4162 Child-Care Dropout Questionnaire	Form
SSA-4162 Child-Care Dropout Questionnaire SSA-4162.pdf	Form

IC Title:

Child-Care Dropout Questionnaire

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 404.211(e)(4)

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-4162	Child-Care Dropout Questionnaire	SSA-4162.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: 2,000

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	2,000	2,000
Annual IC Time Burden (Hours)	167	167
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.