Information Collection

State, Local and Tribal Government

IC 45416 under ICR 200907-0960-007 · OMB 0960-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7160-F4 State, Local and Tribal Government	Form
SSA-7160-F4 Employment Relationship Questionnaire SSA-7160-F4.pdf	Form

IC Title:

State, Local and Tribal Government

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 404.1007

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-7160-F4	Employment Relationship Questionnaire	SSA-7160-F4.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: 800

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	333	333
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.