STATEMENT OF EMPLOYER

ICR 198208-0960-004

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
114323 Migrated
ICR Details
0960-0030 198208-0960-004
Historical Active 198108-0960-008
SSA
STATEMENT OF EMPLOYER
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 10/12/1982
Retrieve Notice of Action (NOA) 08/13/1982
  Inventory as of this Action Requested Previously Approved
10/31/1984 10/31/1984
850,000 0 0
283,333 0 0
0 0 0

THIS FORM IS NEEDED TO OBTAIN WAGE DATA FOR WORKERS WHO HAVE ALLEGED RECEIPT OF WAGES (OTHER THAN AGRICULTURAL WAGES) WHICH DO NOT APPEAR ON SSA'S EARNINGS RECORD. THE INFORMATION IS USED TO PROCESS CLAIMS FOR SOCIAL SECURITY BENEFITS.

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 0 0 850,000 0 0
Annual Time Burden (Hours) 283,333 0 0 283,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
08/13/1982


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