Non-Federal Employer Signers

Incoming and Outgoing Intergovernmental Personnel Act (IPA) Assignment Agreement

Documents and Forms

Document Name Document Type
Form SSA-187 Non-Federal Employer Signers Form and Instruction
Revised PA & PRA Statements.pdf Other-Revised PA & PRA Statements
Revised PA & PRA Statements.pdf Other-Revised PA & PRA Statements
SSA-187 Assignment Agreement Title IV of the Intergovernmental P SSA-187 Revised.PDF www.ssa.gov Form and Instruction
SSA-187 Assignment Agreement Title IV of the Intergovernmental P SSA-187 Revised.PDF www.ssa.gov Form and Instruction
SSA-188 Assignment Agreement Title IV of the Intergovernmental P SSA-188 Revised.PDF www.ssa.gov Form and Instruction
SSA-188 Assignment Agreement Title IV of the Intergovernmental P SSA-188 Revised.PDF www.ssa.gov Form and Instruction
SSA-187 - Current.pdf SSA-187 Current IC Document
SSA-187 - Current.pdf SSA-187 Current IC Document
SSA-188 - Current.pdf SSA-188 Current IC Document
SSA-188 - Current.pdf SSA-188 Current IC Document

Information Collection (IC) Details

IC Title:	Non-Federal Employer Signers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 5 CFR 334

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-187	Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Incoming Assignments	SSA-187 Revised.PDF	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SSA-188	Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Outgoing Assignments	SSA-188 Revised.PDF	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Revised PA & PRA Statements			Revised PA & PRA Statements.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-187 Current	SSA-187 - Current.pdf	08/22/2023
SSA-188 Current	SSA-188 - Current.pdf	08/22/2023

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