SSA-7162-OCR-SM--Report to U.S. SSA

Report to U.S. SSA by Person Receiving Benefits for a Child or Adult Unable to Handle Funds/Report to U.S. SSA

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0049 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-7162-OCR-SM SSA-7162-OCR-SM--Report to U.S. SSA Form and Instruction
Revised PA Statement - SSA-7162-OCR-SM.pdf Other-Revised Privacy Act Statement
SSA-7162-OCR-SM Report to United States Social Security Administration SSA-7162-OCR-SM - Revised Version.pdf Form and Instruction
SSA-7162-OCR-SM - Current Version.pdf Current SSA-7162-OCR-SM IC Document

Information Collection (IC) Details

IC Title:	SSA-7162-OCR-SM--Report to U.S. SSA	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 and Instruction	SSA-7162-OCR-SM	Report to United States Social Security Administration	SSA-7162-OCR-SM - Revised Version.pdf		No		Fillable Printable
Other-Revised Privacy Act Statement			Revised PA Statement - SSA-7162-OCR-SM.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 394,419	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	394,419	30,419	364,000
Annual IC Time Burden (Hours)	32,868	2,535	30,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-7162-OCR-SM	SSA-7162-OCR-SM - Current Version.pdf	08/01/2016

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