Information Collection

Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.

IC 9062 under ICR 201601-0960-001 · OMB 0960-0103.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0103 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7163A-F4 Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.	Form
SSA-L4112 Revised PA Statement.doc	Other-Revised Privacy Act Statement
SSA-7163A-F4 Supplemental Statement Regarding Farming Activities of P ssa-7163a-F4 (Revised fill).pdf	Form
ssa-7163a-F4 (current).pdf Current SSA-7163A-F4	IC Document

IC Title:

Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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-7163A-F4	Supplemental Statement Regarding Farming Activities of Person Living Outside the U.S.A.	ssa-7163a-F4 (Revised fill).pdf		No		Paper Only
Other-Revised Privacy Act Statement			SSA-L4112 Revised PA Statement.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

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	1,000	1,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-7163A-F4	ssa-7163a-F4 (current).pdf	01/28/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.