Employment Relationship Questionnaire

Forms and Documents

Document Name	Status
Form SSA-7160-F4 Individuals or Households Form	Modified
Form SSA-7160-F4 State, Local and Tribal Government Form	New
Form SSA-7160-F4 Private Sector Form	New
Supporting Statement--0040.doc Supporting Statement A	2006-11-01

IC Document Collections

IC ID	Document Title	Status
8948	Individuals or Households Form	Modified
45416	State, Local and Tribal Government Form	New
45415	Private Sector Form	New

ICR Details

OMB Control No: 0960-0040	ICR Reference No: 200609-0960-013
Status: Historical Active	Previous ICR Reference No: 200401-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Employment Relationship Questionnaire
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/26/2007
	Date Received in OIRA: 11/09/2006
Terms of Clearance: This ICR is approved without change. However, SSA will find a more reliable method of keeping track of burden estimates and update them, if necessary, upon next submission.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved	02/28/2007
Responses	16,000	0	47,500
Time Burden (Hours)	6,666	0	19,792
Cost Burden (Dollars)	0	0	0

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Abstract: Form SSA-7160-F4 is used in developing the question of employer-employee relationships, except where the worker is an officer of a corporation. It is an omnibus questionnaire which elicits information for use under both the common-law control test and the occupational group test. This form gathers the information needed for developing the employment relationship, and determining whether a beneficiary is self-employed or an employee. Respondents are beneficiaries questioning their status as employees, and employers.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 410 Name of Law: null
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 43270	07/31/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 64327	11/01/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
State, Local and Tribal Government	SSA-7160-F4	Employment Relationship Questionnaire
Private Sector	SSA-7160-F4	Employment Relationship Questionnaire
Individuals or Households	SSA-7160-F4	Employment Relationship Questionnaire

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ICR Summary 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	16,000	47,500	0	0	-31,500	0
Annual Time Burden (Hours)	6,666	19,792	0	0	-13,126	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: The decrease in the burden hours is due to a decrease in the use of this form. Also, SSA believes that the original estimate was inaccurate, and is now correcting that estimate.

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Annual Cost to Federal Government: $0

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 11/09/2006

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