Missing and Discrepant Wage Reports Letter and Questionnaire

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0432 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-95-SM Missing and Discrepant Wage Reports Letter and Questionnaire Form
SSA-L93-SM 1st Notice Letter Sample.pdf Other-Cover Letter
SSA-L94-SM Followup Notice Letter Sample.pdf Other-Cover Letter
SSA-L93.pdf Other-Revised Cover Letter (mock-up
SSA-L94.pdf Other-Revised Cover Letter (mock-up
SSA-95-SM Employer Questionnaire--SSA Has No Record of Employer Re SSA-95-SM Employer Questionnaire--SSA Has No Record of Employer Report.pdf Form
SSA-97-SM Employer Questionnaire--Discrepancy Between IRS and SSA SSA-97-SM Employer Questionnaire--Discrepancy Between IRS and SSA Records Sample.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Missing and Discrepant Wage Reports Letter and Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 26 CFR 31.6051-2

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-95-SM	Employer Questionnaire--SSA Has No Record of Employer Report	SSA-95-SM Employer Questionnaire--SSA Has No Record of Employer Report.pdf	No	Paper Only
Form	SSA-97-SM	Employer Questionnaire--Discrepancy Between IRS and SSA Records	SSA-97-SM Employer Questionnaire--Discrepancy Between IRS and SSA Records Sample.pdf	No	Paper Only
Other-Cover Letter			SSA-L93-SM 1st Notice Letter Sample.pdf	No	Paper Only
Other-Cover Letter			SSA-L94-SM Followup Notice Letter Sample.pdf	No	Paper Only
Other-Revised Cover Letter (mock-up with changes)			SSA-L93.pdf	No	Paper Only
Other-Revised Cover Letter (mock-up with changes)			SSA-L94.pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 360,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	360,000	360,000
Annual IC Time Burden (Hours)	180,000	180,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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