Employment Relationship Questionnaire

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.