Information Collection

Partnership Questionnaire (completed in or brought to a field office)

IC 269180 under ICR 202404-0960-012 · OMB 0960-0025.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7104 Partnership Questionnaire (completed in or brought to a field office)	Form
Privacy Act Statement (revised).docx	Other-Privacy Act Statement (revised
Privacy Act Statement (revised).docx	Other-Privacy Act Statement (revised
SSA-7104 Partnership Questionnaire SSA-7104 (revised).pdf	Form
SSA-7104 Partnership Questionnaire SSA-7104 (revised).pdf	Form
SSA-7104 (current).pdf SSA-7104 (current)	IC Document
SSA-7104 (current).pdf SSA-7104 (current)	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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-7104	Partnership Questionnaire	SSA-7104 (revised).pdf		No		Paper Only
Other-Privacy Act Statement (revised)			Privacy Act Statement (revised).docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,154

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	2,154	2,154
Annual IC Time Burden (Hours)	3,231	3,231
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-7104 (current)	SSA-7104 (current).pdf	07/03/2024

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