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

Forms and Documents

Document Name	Status
Form SSA-7163A-F4 Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A. Form	Modified
Addendum 0103.doc Supplementary Document	2019-05-22
Supporting Statement - 0103 (Revised).docx Supporting Statement A	2019-09-03

IC Document Collections

IC ID	Document Title	Status
9062	Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A. Form	Modified

ICR Details

OMB Control No: 0960-0103	ICR Reference No: 201903-0960-001
Status: Active	Previous ICR Reference No: 201601-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/04/2019
	Date Received in OIRA: 05/24/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2022	36 Months From Approved	09/30/2019
Responses	1,000	0	1,000
Time Burden (Hours)	1,000	0	1,000
Cost Burden (Dollars)	0	0	0

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Abstract: When a beneficiary or claimant reports farm work from outside the United States, SSA documents this work on Form SSA-7163A-F4. Specifically, SSA uses the form to determine if we should apply foreign work deductions to the recipient's title II benefits. We collect the information either annually or every other year, depending on the respondent's country of residence. Respondents are Social Security recipients engaged in farming activities outside the United States. Once we learn a Social Security recipient is working on a farm outside the United States, SSA employees send the SSA-7163A-F4 either directly to the recipient or to the appropriate Foreign Service Posts if we need assistance in the delivery of the form.

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Authorizing Statute(s): US Code: 42 USC 403 Name of Law: The Social Security Act
   US Code: 42 USC 405 Name of Law: The Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 4597	02/15/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 23623	05/22/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.	SSA-7163A-F4	Supplemental Statement Regarding Farming Activities of Person Living Outside the U.S.A.

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,000	1,000	0	0	0	0
Annual Time Burden (Hours)	1,000	1,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,540

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/24/2019

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