State, Local and Tribal Government

Employment Relationship Questionnaire

OMB: 0960-0040

IC ID: 45416

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

State, Local and Tribal Government
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1007

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Revised PA Statement Revised PA Statement.pdf Yes No Fillable Printable
Form SSA-7160-F4 Employment Relationship Questionnaire SSA-7160 - Revised.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

 

800 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 800 0 0 0 0 800
Annual IC Time Burden (Hours) 333 0 0 0 0 333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-7160 - Current SSA-7160 - Current.pdf 07/24/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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