0960-0030 Supporting Statement Revised

Supporting Statement for Form SSA-7011,

Statement of Employer

20 CFR 404.801-404.803

OMB # 0960-0030

1. Justification

1. Section 205(a) of the Social Security Act (the Act) provides that the Commissioner of Social Security (the Commissioner) shall have full power and authority to make rules, regulations, and procedures necessary to carry out provisions of the Act. Section 205(c)(2)(A) of the Act charges the Commissioner with establishing and maintaining records of the amounts of wages paid to, and the amounts of self-employment income derived by individuals Section 205(d) of the Act provides the authority for the Social Security Administration (SSA) to issue a subpoena if an employer refuses to furnish the requested information. 20 CFR 404.801 – 404.802 describe the procedures SSA uses to implement section 205(c)(2)(A) of the Act. 20 CFR 404.803 explains that the amounts of earnings credited to an individual and the periods to which such earnings are credited, may be proved by the records of SSA, and by other evidence of probative value.

2. SSA uses Form SSA-7011-F4 to substantiate allegations that earnings posted to the individual’s security record are incorrect, wages paid to the individual do not appear in SSA’s records of earnings, or the individual has no proof of said earnings. SSA uses the information received on this form to process claims for social security benefits and to resolve discrepancies in the individual’s social security earnings record. We only send Form SSA-7011-F4 to employers if we deem it necessary; in many situations, we are able to locate the earnings information within our records, without having to contact the employer. The respondents are certain employers who can verify wage allegations made by the wage earners.

3. Improved information technology which would reduce the burden is not currently available. An electronic version is not available due to budget and human resources constraints; therefore, higher volume forms take precedence.

4. The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to collect similar data.

5. SSA does not request wage data from an employer unless the individual is unable to furnish wage evidence. This minimizes the burden on small businesses. This collection does not significantly affect a substantial number of small businesses or other small entities.

6. If SSA did not collect the information, it would result in incorrect payments or incorrect denials. In addition, since SSA collects this information on an as needed basis, we cannot collect it less frequently. There are no technical or legal obstacles that prevent burden reduction.

7. There are no special circumstances that would cause SSA to conduct this information collection in a manner that is not consistent with 5 CFR 1320.5.

8. The 60-day advance Federal Register Notice published on April 7, 2009, at 74 FR 15808, and SSA received no public comments. The second Notice published on June 09, 2009, at 74 FR 27379. There has been no outside consultation with members of the public.

9. SSA provides no payment or gifts to the respondents.

10. The information requested is protected and held confidential in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 522 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.

11. The information collection does not contain any questions of a sensitive nature.

12, Approximately 925,000 respondents use Form SSA-7011 annually. The estimated average response time is 20 minutes, for a total of 30,833 burden hours. The total burden represents burden hours, and SSA did not calculate a separate cost burden

The information collection does not mandate the type of respondent, other than employer, nor is there a mechanism to capture this information. It would not be cost effective to determine the type of respondent, other than employer, and would place an additional collection burden upon the respondent.

13. There is no known cost burden to the respondents.

14. The annual cost to the Federal Government is approximately $2,849,000. This estimate is a projection of the costs for printing and distributing the collection instrument for collecting the information.

15. There is no change in public reporting burden.

16. SSA will not publish the results of the information collection.

17. OMB exempted SSA from the requirement to print the OMB approval expiration date on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). OMB granted this exemption so the agency would not have to discontinue using otherwise useable editions of forms with outdated expiration dates. In addition, SSA avoids Government waste, because we will not have to destroy and reprint stocks of forms.

18. SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

B. Collections of Information Employing Statistical Methods

SSA is not using statistical methods for this information collection.