SSA-7156

Farm Self Employment Questionnaire

Download and Print the SSA-7156

Request may not be processed if the form is incomplete or illegible.

Privacy Act/Paperwork Act Notice:
The questions on this form are authorized by section 211 (a) of the Social Security Act, as amended (42 U.S.C. 411). While it is not mandatory for you to complete this form, failure to answer the following questions would cause the Social Security Administration to make a decision on your claim based on the information available. The information that you provide on this form will be used to determine if you are self-employed as a farmer, and it may affect your eligibility for social security benefits.

We may also use the information you give us when we match records by computer. Matching programs compare our records with those of other Federal, State, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree to it.
These and other reasons why information about you may be used or given out are explained in the Federal Register . If you want to learn more about this, contact any Social Security office.

1. NAME OF SELF-EMPLOYED PERSON
SOCIAL SECURITY NUMBER

2. THIS RELATES TO PERIOD (DATES)
FROM - TO

DID YOU LIVE ON THE FARM DURING THIS PERIOD?
YES - NO
IF ''NO,'' HOW FAR FROM THE FARM DID YOU LIVE?

3. HOW LARGE WAS THE FARMING OPERATION DURING THIS PERIOD? (Total acreage, acreage cultivated, crop allotments, usual size of herds, etc.)

4. WHAT WAS YOUR STATUS WITH REGARD TO THIS FARMING OPERATION? (Check appropriate box or boxes according to local terminology)
OWNER - OWNER- OPERATOR - PARTNER - LANDLORD - TENANT - SHARECROPPER -
OTHER (Specify)

5. DID ANY OTHER PERSON WORK OR HELP WORK THE FARM? IF "YES." ANSWER (A). (B). (C).
YES - NO
(A) NAME OF THE OTHER PERSON(S) AND FAMILY RELATIONSHIP. IF ANY.
(B) WHAT DID THE OTHER PERSON DO IN CONNECTION WITH THE FARMING OPERATION?
(C) HOW WAS THE OTHER PERSON PAID?

And much more...