Addendum to the Supporting Statement 0960-0030

Addendum to the Supporting Statement for

Form SSA-7011-F4, Statement of Employer

20 CFR 404.801-404.803

OMB No. 0960-0030

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

• Change 1: We are revising line 4:

  • Old Language: “Did you submit wage report Forms W-2 and W-3, or equivalent magnetic media reports”.

• New Language: “Did you submit wage report Forms W-2 and W-3, or equivalent electronic reports”,

• Justification 1: We are changing the language, because SSA no longer uses magnetic media reports, we use electronic reports.

• Change #2: We are revising the PRA Statement on this form.

Justification #2: We are revising the PRA Statements on all agency forms to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.

• Change #3: We are revising the Privacy Act Statement on this form.

Justification #3: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the first page of the form.