View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0960-0040	ICR Reference No: 202109-0960-008
Status: Historical Active	Previous ICR Reference No: 201804-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Employment Relationship Questionnaire
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/26/2023
	Date Received in OIRA: 09/30/2021
Terms of Clearance: Prior to triannual renewal, SSA will ensure that the signature field can be electronically signed (i.e. a typed signature).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	36 Months From Approved	09/30/2023
Responses	45	0	16,000
Time Burden (Hours)	19	0	6,666
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	45	16,000	-15,955
Annual Time Burden (Hours)	19	6,666	-6,647
Annual Cost Burden (Dollars)	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: We are showing a large decrease in the use of this form since we last reported usage in 2018. There are two reasons for this decrease: 1) there has been a significant decrease in the need for Form SSA-7160, and 2) our previously reported numbers were based on old, and possibly inaccurate management information data. We have since updated SSA’s system to allow us to better calculate the usage of this form and have found that we overestimated the use when we reported it last. Finally, we also note that our new system does not require the field office to record the type of respondent; therefore, we are reporting the burden data in one IC that covers all the respondents. While the number of respondents has decreased, SSA did not take any actions to cause this change. These figures represent current management information data.

Annual Cost to Federal Government: $13,356

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

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

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