Information Collection

Employment Relationship Questionnaire

IC 8948 under ICR 202109-0960-008 · OMB 0960-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7160-F4 Employment Relationship Questionnaire	Form
SSA-7160 - Revised PA and PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA-7160-F4 Employment Relationship Questionnaire SSA-7160 - Revised Version.pdf www.ssa.gov	Form
SSA-7160 - Current Version.pdf Current Version of the SSA-7160	IC Document

IC Title:

Employment Relationship Questionnaire

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 404.1007

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-7160-F4	Employment Relationship Questionnaire	SSA-7160 - Revised Version.pdf	www.ssa.gov	Yes	No	Printable Only
Other-Revised PA and PRA Statements			SSA-7160 - Revised PA and PRA Statements.pdf		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: 45

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	45	-7,955	8,000
Annual IC Time Burden (Hours)	19	-3,314	3,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current Version of the SSA-7160	SSA-7160 - Current Version.pdf	09/27/2021

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