Information Collection

Questionnaire About Employment or Self-Employment Outside the United States

IC 8964 under ICR 202501-0960-004 · OMB 0960-0050.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7163 Questionnaire About Employment or Self-Employment Outside the United States	Form
Form SSA-7163 Questionnaire About Employment Or Self-Employment Outside The United States Questionnaire About Employment or Self-Employment Outside the United States	Form
SSA-7163 Questionnaire About Employment Or Self-Employment Outsid ssa-7163 Mockup.pdf	Form
SSA-7163 Questionnaire About Employment Or Self-Employment Outsid ssa-7163 Mockup.pdf	Form
SSA-7163 Current.pdf Questionnaire About Employment Or Self-Employment Outside The United States	IC Document
SSA-7163 Current.pdf Questionnaire About Employment Or Self-Employment Outside The United States	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 404.415 20 CFR 404.417 20 CFR 404.401(b)(1)

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-7163				Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

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	20,000	20,000
Annual IC Time Burden (Hours)	20,000	20,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Questionnaire About Employment Or Self-Employment Outside The United States		01/17/2025

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

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