Information Collection

Employee Identification Statement

IC 9364 under ICR 200801-0960-007 · OMB 0960-0473.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0473 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4156 Employee Identification Statement	Form
SSA-4156 Employee Identification Statement SSA-4156.pdf	Form

IC Title:

Employee Identification Statement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.702

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-4156	Employee Identification Statement	SSA-4156.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: 4,750

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,750	4,750
Annual IC Time Burden (Hours)	792	792
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.