Non-Federal Employer Signers

Incoming and Outgoing Intergovernmental Personnel Act (IPA) Assignment Agreement

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.