Information Collection

SSA-7162-OCR-SM--Report to U.S. SSA

IC 178733 under ICR 202601-0960-001 · OMB 0960-0049.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7162-OCR-SM Report to United States Social Security Administration SSA-7162-OCR-SM--Report to U.S. SSA	Form and Instruction
SSA-7162-INST.pdf	Instruction
SSA-7162-OCR-SM Report to United States Social Security Administration SSA-7162 -OCR-SM (revised).pdf	Form and Instruction
SSA-7162-OCR-SM (current).pdf SSA-7162-OCR-SM (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:

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-7162-OCR-SM				No		Fillable Printable
Instruction					No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 352,956

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	352,956	-73,492	426,448
Annual IC Time Burden (Hours)	517,669	482,132	35,537
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-7162-OCR-SM (current)		01/07/2026

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

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