Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-7163A-F4 Supplemental Statement Regarding Farming Activities of Person Living Outside the U.S.A.	Form	Modified	Available
Form SSA-7163A-F4 Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.	Form	Modified	Repair queued
Justification for Non-Substantive Changes 0960-0103.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-10-24	Available
Justification for Non-Substantive Changes 0960-0103.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-10-24	Repair queued
Addendum - 0103 (Final).docx	Supplementary Document	Uploaded 2022-08-26	Repair queued
Addendum - 0103 (Final).docx	Supplementary Document	Uploaded 2022-08-26	Repair queued
Supporting Statement - 0103 (Final).docx	Supporting Statement A	Uploaded 2022-09-02	Available
Supporting Statement - 0103 (Final).docx	Supporting Statement A	Uploaded 2022-09-02	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9062	Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.	Form	Modified	Supplemental Statement Regarding Farming Activities of Person Living Outside the U.S.A.
9062	Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.	Form	Modified

ICR Details

OMB Control No: 0960-0103	ICR Reference No: 202410-0960-019
Status: Active	Previous ICR Reference No: 202205-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/24/2024
Terms of Clearance: In accordance with 5 CFR 1320, this information collection is approved.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	09/30/2026	09/30/2026
Responses	19	0	19
Time Burden (Hours)	19	0	19
Cost Burden (Dollars)	0	0	0

---

Abstract: When a beneficiary or claimant reports farm work from outside the United States, SSA documents this work on Form SSA-7163A-F4. Specifically, SSA uses the form to determine if we should apply foreign work deductions to the recipient's Title II benefits. We collect the information either annually or every other year, depending on the respondent's country of residence. Respondents are Social Security recipients engaged in farming activities outside the United States. Once we learn a Social Security recipient is working on a farm outside the United States, SSA employees send the SSA-7163A-F4 either directly to the recipient or to the appropriate Foreign Service Posts if we need assistance in the delivery of the form. We are submitting this non-substantive change request to remove the signature requirement, replacing the Penalty of Perjury Statemenwith with a Penalty of Perjury Warning Statement

---

Authorizing Statute(s): US Code: 42 USC 403 Name of Law: The Social Security Act
   US Code: 42 USC 405 Name of Law: The Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 37899	06/24/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 52605	08/26/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.	SSA-7163A-F4	Supplemental Statement Regarding Farming Activities of Person Living Outside the U.S.A.

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	19	19	0	0	0	0
Annual Time Burden (Hours)	19	19	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2019, the burden was 1,000 hours. However, we are currently reporting a burden of 19 hours. This change stems from a large decrease in the number of responses from 1,000 to19 from 2019 to 2022. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.

---

Annual Cost to Federal Government: $5,930

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/24/2024

---