Information Collection

Non-Federal Employee Respondent

IC 199023 under ICR 202308-0960-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-187 Non-Federal Employee Respondent	Form and Instruction
Form SSA-187 Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Incoming Assignments Non-Federal Employee Respondent	Form and Instruction
Form SSA-188 Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Outgoing Assignments Non-Federal Employee Respondent	Form and Instruction
Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
SSA-187 Assignment Agreement Title IV of the Intergovernmental P SSA-187 Revised.PDF	Form and Instruction
SSA-187 Assignment Agreement Title IV of the Intergovernmental P SSA-187 Revised.PDF	Form and Instruction
SSA-188 Assignment Agreement Title IV of the Intergovernmental P SSA-188 Revised.PDF	Form and Instruction
SSA-188 Assignment Agreement Title IV of the Intergovernmental P SSA-188 Revised.PDF	Form and Instruction
SSA-187 - Current.pdf SSA-187 Current	IC Document
SSA-187 - Current.pdf SSA-187 Current	IC Document
SSA-188 - Current.pdf SSA-188 Current	IC Document
SSA-188 - Current.pdf SSA-188 Current	IC Document

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:

table that charts list of 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.PDF	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SSA-188	Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Outgoing Assignments	SSA-188 Revised.PDF	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Revised PA & PRA Statements			Revised PA & PRA Statements.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-187 Current	SSA-187 - Current.pdf	08/22/2023
SSA-188 Current	SSA-188 - Current.pdf	08/22/2023

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