Information Collection

Employee Identification Statement

IC 9364 under ICR 201701-0960-002 · OMB 0960-0473.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0473 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4156 Employee Identification Statement	Form
Revised Privacy Act Statement - SSA-4156.pdf	Other-Revised Privacy Act Statement
SSA-4156 Employee Identification Statement SSA-4156 - Revised Version.pdf	Form
SSA-4156 - Current Version.pdf Current SSA-4156	IC Document

IC Title:

Employee Identification Statement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.702

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-4156	Employee Identification Statement	SSA-4156 - Revised Version.pdf		No		Paper Only
Other-Revised Privacy Act Statement			Revised Privacy Act Statement - SSA-4156.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: 4,750

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,750	4,750
Annual IC Time Burden (Hours)	792	792
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-4156	SSA-4156 - Current Version.pdf	05/02/2017

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