Employment Relationship Questionnaire

ICR 200907-0960-007

OMB: 0960-0040

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Form
Modified
Form
Modified
Supplementary Document
2009-10-26
Supporting Statement A
2009-12-10
IC Document Collections
IC ID
Document
Title
Status
8948 Modified
45416 Modified
45415 Modified
ICR Details
0960-0040 200907-0960-007
Historical Active 200609-0960-013
SSA
Employment Relationship Questionnaire
Extension without change of a currently approved collection   No
Regular
Approved without change 03/11/2010
Retrieve Notice of Action (NOA) 12/10/2009
  Inventory as of this Action Requested Previously Approved
03/31/2013 36 Months From Approved 03/31/2010
16,000 0 16,000
6,666 0 6,666
0 0 0

SSA obtains information on Form SSA–7160–F4 to determine a worker’s employment status; i.e., whether, under the definition of an employee found in Section 210(j)(2) of the Act and 20 CFR 404.1007 of the Code of Federal Regulations, a worker is an employee under the ‘‘usual common law rules’’ applicable in determining the existence of an employer-employee relationship. We use the information to develop the employment relationship, and to determine whether a beneficiary is self-employed or an employee. The respondents are individuals questioning their status as employees and their alleged employers.

US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 410 Name of Law: null
  
None

Not associated with rulemaking

  74 FR 39728 08/07/2009
74 FR 64801 12/08/2009
No

  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 16,000 0 0 0 0
Annual Time Burden (Hours) 6,666 6,666 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
No
Uncollected
Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/10/2009


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