OMB control number
Tribal Council Coverage Agreement
OMB 0960-0812 ยท SSA.
OMB 0960-0812
SSA uses the Tribal Council Coverage Agreement to collect information if a tribe wishes to obtain Social Security coverage. Each tribe requesting coverage fills out an agreement, and SSA employees collect the information via form SSA-177 or SSA-177-OP1. The respondents are Indian tribal councils who wish to receive Social Security coverage for their members.
The latest form for Tribal Council Coverage Agreement expires 2026-06-30 and is listed under ICR 202109-0960-003.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Supporting Statement - 0812 (Final).docx | Supporting Statement A |
| Supporting Statement - 0812 (Final).docx | Supporting Statement A |
 Tribal Council Coverage Agreement |
Other-Indian Tribal Council Coverage Agreement |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202109-0960-003 | Revision of a currently approved collection | 2022-03-22 | ||
| 201911-0960-002 | No material or nonsubstantive change to a currently approved collection | 2019-11-06 | Approved without change | |
| 201812-0960-001 | New collection (Request for a new OMB Control Number) | 2019-03-29 | Approved without change |