View Information Collection Request (ICR) Package

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: 0960-0138	ICR Reference No: 202011-0960-001
Status: Historical Active	Previous ICR Reference No: 201710-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Letter to Employer Requesting Wage Information
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/22/2023
	Date Received in OIRA: 03/15/2021
Terms of Clearance: The agency made clarifying edits to the supporting statement. When the agency submits this information collection for re-approval, it will make minor additions to the response to Question Prompt #2 in the Supporting Statement to explain the differences between the questions asked on the SSA-L725 and the SSA-4201 and the policy reasons for these differences. The agency will also make minor additions to #2 to add in additional explanation for why developing this income information from the employer can be particularly useful for identifying the time and timeline for income a beneficiary many have received.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	36 Months From Approved	06/30/2023
Responses	133,000	0	133,000
Time Burden (Hours)	66,500	0	66,500
Cost Burden (Dollars)	0	0	0

Annual Cost to Federal Government: $2,007,420

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

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? No

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

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