OMB control number

Tribal Council Coverage Agreement

OMB 0960-0812 · 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 2026-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Supporting Statement - 0812 (Final).docx Supporting Statement A
Tribal Council Coverage Agreement Other-Indian Tribal Council Coverage Agreement

All Historical Document Collections

202109-0960-003	Revision of a currently approved collection	2022-03-22
201911-0960-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-11-06
201812-0960-001 Approved without change	New collection (Request for a new OMB Control Number)	2019-03-29