Tribal Council Coverage Agreement

OMB 0960-0812

OMB 0960-0812

SSA will use the Tribal Council Coverage Agreement to collect information if a tribe wishes to obtain Social Security coverage. Each tribe requesting coverage fills out an agreement, and SSA employees collect this information via the paper agreement. The respondents are Indian tribal councils who wish to receive Social Security coverage for their members. We are making non-substantive changes to Form SSA-177 to account for Tribe’s government organizations that do not identify as “tribal council”.

The latest form for Tribal Council Coverage Agreement expires 2022-05-31 and can be found here.

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