View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0030
ICR Reference No:
201505-0960-010
Status:
Historical Active
Previous ICR Reference No:
201206-0960-011
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Statement of Employer
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
10/22/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/18/2015
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
10/31/2018
36 Months From Approved
11/30/2015
Responses
500
0
462,000
Time Burden (Hours)
167
0
154,000
Cost Burden (Dollars)
0
0
0
Abstract:
SSA uses Form SSA-7011-F4 to substantiate allegations that earnings posted to the individuals security record are incorrect, wages paid to the individual do not appear in SSAs 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 individuals 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.
Authorizing Statute(s):
US Code:
42 USC 405
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
80 FR 30316
05/27/2015
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 53608
09/04/2015
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Statement of Employer
SSA-7011-F4
Statement of Employer
ICR Summary of Burden
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
500
462,000
0
0
-461,500
0
Annual Time Burden (Hours)
167
154,000
0
0
-153,833
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
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, and 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 the use of Form SSA-7011-F4.
Annual Cost to Federal Government:
$1,000,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
Common Form ICR:
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:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(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;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
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.
Certification Date:
09/18/2015
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