Information Collection

Questionnaire About Employment or Self-Employment Outside the United States

IC 8964 under ICR 201612-0960-006 · OMB 0960-0050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7163 Questionnaire About Employment or Self-Employment Outside the United States	Form
0050 PRA revised.doc	Other-Revised Paperwork Reduction Ac
0050 Privacy Act Statement.doc	Other-Revised Privacy Act Statement
SSA-7163 Questionnaire About employment or Self Employment Outsid SSA-7163 - Revised Version.pdf	Form
SSA-7163 - Current Version.pdf Current SSA-7163	IC Document

IC Title:

Questionnaire About Employment or Self-Employment Outside the United States

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 404.401(b)(1) 20 CFR 404.415 20 CFR 404.417

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7163	Questionnaire About employment or Self Employment Outside the United States	SSA-7163 - Revised Version.pdf	No		Paper Only
Other-Revised Paperwork Reduction Act			0050 PRA revised.doc	Yes	No	Printable Only
Other-Revised Privacy Act Statement			0050 Privacy Act Statement.doc	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

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	20,000	20,000
Annual IC Time Burden (Hours)	4,000	4,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-7163	SSA-7163 - Current Version.pdf	01/10/2014

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