Information Collection

Questionnaire About Employment or Self-Employment Outside the United States

IC 8964 under ICR 202004-0960-010 · OMB 0960-0050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0050 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-7163 Questionnaire About Employment or Self-Employment Outside the United States Form
Revised PA & PRA Statements.pdf Other-Revised PA & PRA Statements
SSA-7163 Questionnaire About employment or Self Employment Outsid SSA-7163 - Revised.pdf Form
SSA-7163 - Current.pdf SSA-7163 - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Questionnaire About Employment or Self-Employment Outside the United States	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.415 20 CFR 404.417 20 CFR 404.401(b)(1)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7163	Questionnaire About employment or Self Employment Outside the United States	SSA-7163 - Revised.pdf		Yes	No	Fillable Printable
Other-Revised PA & PRA Statements			Revised PA & PRA Statements.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20,000	0	20,000
Annual IC Time Burden (Hours)	20,000	16,000	4,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-7163 - Current	SSA-7163 - Current.pdf	08/24/2020

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