STATEMENT OF EMPLOYER

ICR 198008-0960-001

OMB: 0960-0030

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
114320 Migrated
ICR Details
0960-0030 198008-0960-001
Historical Active 197903-0960-008
SSA
STATEMENT OF EMPLOYER
Revision of a currently approved collection   No
Regular
Approved without change 11/13/1980
Retrieve Notice of Action (NOA) 08/05/1980
  Inventory as of this Action Requested Previously Approved
06/30/1981 06/30/1981 09/30/1982
850,000 0 850,000
283,333 0 283,000
0 0 0

THIS FORM IS NEEDED IN ORDER FOR SSA TO RESOLVE WAGE DISCREPANCIES WHERE WAGES WERE NOT REPORTED OR INCORRECTLY REPORTED. THE INFORMATION IS USED IN DETERMINING THE AMOUNT OF SOCIAL SECURITY BENEFITS PAYABLE OR POTENTIALLY PAYABLE ON THE INDIVIDUAL'S EARNINGS RECORD.

None
None


No

1
IC Title Form No. Form Name
STATEMENT OF EMPLOYER SSA-7011

  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 850,000 850,000 0 0 0 0
Annual Time Burden (Hours) 283,333 283,000 0 0 333 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
08/05/1980


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