Statement of Employer

ICR 201206-0960-011

OMB: 0960-0030

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2012-10-03
Supporting Statement A
2012-10-03
IC Document Collections
IC ID
Document
Title
Status
43689 Modified
ICR Details
0960-0030 201206-0960-011
Historical Active 200903-0960-002
SSA
Statement of Employer
Revision of a currently approved collection   No
Regular
Approved without change 11/11/2012
Retrieve Notice of Action (NOA) 10/04/2012
  Inventory as of this Action Requested Previously Approved
11/30/2015 36 Months From Approved 11/30/2012
462,000 0 925,000
154,000 0 308,333
0 0 0

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.

US Code: 42 USC 405 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  77 FR 40400 07/09/2012
77 FR 59690 09/28/2012
No

1
IC Title Form No. Form Name
Statement of Employer SSA-7011-F4 Statement of Employer

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 462,000 925,000 0 0 -463,000 0
Annual Time Burden (Hours) 154,000 308,333 0 0 -154,333 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The reduction in burden hours stems from a decrease in the number of respondents. In addition, employers' increase use of electronic reporting during the Annual Wage reporting process increased the speed at which SSA posts earnings, recognizes, and corrects errors in employer reports. Consequently, the incidence of erroneous postings on SSA's earnings records substantially decreased within the past three years. Finally, within the past several years, SSA streamlined development requirements for identifying and resolving potential earnings errors when an individual contacts SSA alleging incorrect earnings on their record. As a result, we decreased use of form SSA-7011.

$1,428,000
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/04/2012


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