Addendum

ADDENDUM TO SUPPORTING STATEMENT for Forms

SSA-L2765, Request for Self-Employment Information

SSA-L3365, Request for Employee Information

SSA-L4002, Request for Employer Information

OBM# 0960-0508

Revision to the Collection Instrument for Form:

SSA-L4002, Request for Employer Information

SSA needs the information collected by use of this form in order to credit the reported earnings to the proper earnings record. When Form W-2 wage data for an individual cannot be identified, the data are placed in the Earnings Suspense File, and SSA sends correspondence to the employer in an attempt to obtain the correct employee’s name and Social Security number. These notices are sent out in January for the previous tax year. The revisions below are necessary to simplify the letters for the respondent’s reading.

The following changes will made to the TY 2007 Form:

• Page 2, we placed “THIS IS WHAT YOU NEED TO DO” on the top of the form and placed “REQUEST FOR EMPLOYER INFORMATION” on the bottom. The instructions now appear first and the requested information is to be filled out below. 

 

• Question #1 was changed from "Compare the information shown above to your employment records." to "Compare the information shown on the front of this letter to your employment records."  

• Question #5 was changed from "Fill in the information above and return this letter in the enclosed envelope.” to "Fill in the requested information below and return this letter in the enclosed envelope."

 

• Question #4: The sentence was changed from: "If you or the employee have been using an incorrect name or Social Security number, you must correct it." to "If you or the employee has been using an incorrect name or Social Security number, you must correct it."  (Grammatical change).

*Beginning in TY 2007, the Agency will obsolete the previous version of Form SSA-4002 and destroy all existing stock. The Agency will discontinue use of the previous form (TY 2006) since the form will contain slightly different information in a new format on one of the pages.