Information Collection

Non-Federal Employer Signers

IC 199024 under ICR 201108-0960-009 · OMB 0960-0792.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0792 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-187 Non-Federal Employer Signers	Form and Instruction
SSA-187 Assignment Agreement Title IV of the Intergovernmental P SSA-187.pdf	Form and Instruction
SSA-188 Assignment Agreement Title IV of the Intergovernmental P SSA-188.pdf	Form and Instruction

IC Title:

Non-Federal Employer Signers

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 5 CFR 334

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 and Instruction	SSA-187	Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Instructions for Incoming Assignments	SSA-187.pdf		No		Fillable Printable
Form and Instruction	SSA-188	Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Instructions for Outgoing Assignments	SSA-188.pdf		No		Fillable Printable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	2	2
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.