Statement of Agricultural Employer (Year Prior to 1988; 1988 and Later)

ICR 201609-0960-002

OMB: 0960-0036

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Form
Modified
Supporting Statement A
2017-03-15
Supplementary Document
2017-02-21
IC Document Collections
IC ID
Document
Title
Status
8936 Modified
182041 Modified
ICR Details
0960-0036 201609-0960-002
Active 201310-0960-002
SSA
Statement of Agricultural Employer (Year Prior to 1988; 1988 and Later)
Revision of a currently approved collection   No
Regular
Approved without change 09/29/2017
Retrieve Notice of Action (NOA) 03/15/2017
In accordance with 5 CFR 1320, the information collection is approved for three years.
  Inventory as of this Action Requested Previously Approved
09/30/2020 36 Months From Approved 09/30/2017
32,500 0 32,500
16,250 0 16,250
0 0 0

The information from Forms SSA-1002-F3 and SSA-1003-F3 is used by SSA to resolve discrepancies when farm workers allege their employers did not report their wages, or reported the wages incorrectly. If an agricultural employer has incorrectly reported wages, or failed to report any wages for an employee, SSA must attempt to correct its records by contacting the employer to obtain convincing evidence of the wages paid. The respondents are agricultural employers having knowledge of wages paid to agricultural employees.

US Code: 42 USC 409 Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  81 FR 68088 10/03/2016
82 FR 11293 02/21/2017
No

2
IC Title Form No. Form Name
SSA-1002-F3 SSA-1002-F3 Statement of Agricultural Employer (Years Prior to 1988)
SSA-1003-F3 SSA-1003-F3 Statement of Agricultural Employer for Years 1988 and Later

  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 32,500 32,500 0 0 0 0
Annual Time Burden (Hours) 16,250 16,250 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$7,200
No
    Yes
    Yes
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.
03/15/2017


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