Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0103 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-7163A-F4 Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A. Form
SSA-L4112 Revised PA Statement.doc Other-Revised Privacy Act Statement
SSA-7163A-F4 Supplemental Statement Regarding Farming Activities of P ssa-7163a-F4 (Revised fill).pdf Form
ssa-7163a-F4 (current).pdf Current SSA-7163A-F4 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7163A-F4	Supplemental Statement Regarding Farming Activities of Person Living Outside the U.S.A.	ssa-7163a-F4 (Revised fill).pdf		No		Paper Only
Other-Revised Privacy Act Statement			SSA-L4112 Revised PA Statement.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-7163A-F4	ssa-7163a-F4 (current).pdf	01/28/2016

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