SSA-L725 Letter to Employer Requesting Information About Wages Ea

Form SSA-L725 (07-2023) UF
Discontinue Prior Editions
Social Security Administration

Page 1 of 3
OMB No. 0960-0034

SOCIAL SECURITY
Date:
Refer to:

Social Security
Number:
Worker's Name:

•

Area Code:
Telephone:

So that we may determine the above-named person's eligibility for Social Security benefits, please
furnish the amount of gross wages earned by the employee in each of the months checked below. If
no wages were earned in a month, show "none."
Please note that we need to know the amounts earned for services performed within the calendar
month, regardless of the amounts paid. If the employee received cash tips, include the amount in the
totals for the month.
We appreciate your cooperation in furnishing this information. An envelope requiring no postage is
enclosed for your convenience. A computerized printout in any format may be substituted for the
enclosed form.
Sincerely Yours,

Enclosure

Ending Date of Employment:

Beginning Date of Employment:

If the amount of wages for each month is the same, enter the
monthly amount here.

Year:
January

$

April

$

July

$

October

February

May

August

November

March

June

September

December

See other side for additional years (check if applicable).

$

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Form SSA-L725 (07-2023) UF
If the amount of wages for each month is the same, enter the
monthly amount here.

Year:
January

$

April

$

July

$

October

February

May

August

November

March

June

September

December

If the amount of wages for each month is the same, enter the
monthly amount here.

Year:
January

$

April

$

July

$

October

February

May

August

November

March

June

September

December

$

April

July

$

$

October

February

May

August

November

March

June

September

December

$

If the amount of wages for each month is the same, enter the
monthly amount here.

Year:
January

$

If the amount of wages for each month is the same, enter the
monthly amount here.

Year:
January

$

$

April

$

July

$

October

February

May

August

November

March

June

September

December

$

I declare under penalty of perjury that I have examined all the information on this form, and on any
accompanying statements or forms, and it is true and correct to the best of my knowledge.

EMPLOYER

NAME

AREA CODE AND TELEPHONE NO.

TITLE

DATE

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Form SSA-L725 (07-2023) UF

Privacy Act Statement
Collection and Use of Personal information
Sections 205(a) and 223(d) of the Social Security Act, as amended, allow us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the information may
prevent us from making an accurate and timely decision on any claim filed or could result in the loss of
benefits.
We will use the information you provide to verify wages, resolve wage discrepancies, and determine benefit
eligibility. We may also share the information for the following purposes, called routine uses:
• To employers or former employers, including State Social Security administrators, for correcting and
reconstructing State employee earnings records and for Social Security purposes; and
• To contractors and other Federal Agencies, as necessary, for the purpose of assisting the Social
Security Administration (SSA) in the efficient administration of its programs. We will disclose
information under this routine use only in situations in which SSA may enter into a contractual or
similar agreement with a third party to assist in accomplishing an Agency function relating to this
system of records.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For
example, where authorized, we may use and disclose this information in computer matching programs, in
which our records are compared with other records to establish or verify a person's eligibility for Federal
benefit programs and for repayment of incorrect or delinquent debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN) 60-0059,
entitled Earnings Recording and Self-Employment Income System, as published in the Federal Register (FR)
on January 11, 2006, at 71 FR 1819, 60-0089, entitled Claims Folders System, as published in the FR on
October 31, 2019, at 84 FR 58422, and 60-0330, entitled eWork, as published in the FR on September 15,
2003, at 68 FR 54037. Additional information, and a full listing of all of our SORNs, is available on our website
at www.ssa.gov/privacy.

Paperwork Reduction Act Statement
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. §
3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these
questions unless we display a valid Office of Management and Budget (OMB) control number. We estimate
that it will take about 40 minutes to read the instructions, gather the facts, and answer the questions. Send
only comments regarding this burden estimate or any other aspect of this collection, including
suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.