Information Collection

Employment Relationship Questionnaire

IC 8948 under ICR 202404-0960-007 · OMB 0960-0040.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7160-F4 Employment Relationship Questionnaire	Form
Form SSA-7160-F4 Employment Relationship Questionnaire	Form
SSA-7160-F4 Employment Relationship Questionnaire SSA-7160 (revised).pdf www.ssa.gov	Form
SSA-7160-F4 Employment Relationship Questionnaire SSA-7160 (revised).pdf www.ssa.gov	Form
SSA-7160 (current).pdf SSA-7160 (current)	IC Document
SSA-7160 (current).pdf SSA-7160 (current)	IC Document

IC Title:

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).pdf	www.ssa.gov	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
	Approved	Previously Approved
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-7160 (current)	SSA-7160 (current).pdf	04/26/2024

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