Information Collection

Non-Federal Employee Respondent

IC 199023 under ICR 201706-0960-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-187 Non-Federal Employee Respondent Form and Instruction
SSA- 187 - Revised Privacy Act Statement.pdf Other-Revised Privacy Act Statement
SSA- 188 - Revised Privacy Act Statement.pdf Other-Revised Privacy Act Statement
SSA-187 Assignment Agreement Title IV of the Intergovernmental P SSA-187 - Revised Version.pdf www.ssa.gov Form and Instruction
SSA-188 Assignment Agreement Title IV of the Intergovernmental P SSA-188 - Revised Version.pdf www.ssa.gov Form and Instruction
SSA-187 - Current Version.pdf SSA-187 Current Version IC Document
SSA-188 - Current Version.pdf SSA-188 Current Version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Non-Federal Employee Respondent	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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: Incoming Assignments	SSA-187 - Revised Version.pdf	www.ssa.gov	Yes	No	Fillable Printable
Form and Instruction	SSA-188	Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Outgoing Assignments	SSA-188 - Revised Version.pdf	www.ssa.gov	Yes	No	Fillable Printable
Other-Revised Privacy Act Statement			SSA- 187 - Revised Privacy Act Statement.pdf		Yes	No	Printable Only
Other-Revised Privacy Act Statement			SSA- 188 - Revised Privacy Act Statement.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-187 Current Version	SSA-187 - Current Version.pdf	09/20/2017
SSA-188 Current Version	SSA-188 - Current Version.pdf	09/20/2017

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