STATES REPORT OF ADJUSTMENTS

ICR 198412-0960-008

OMB: 0960-0044

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
114395 Migrated
ICR Details
0960-0044 198412-0960-008
Historical Active 198408-0960-025
SSA
STATES REPORT OF ADJUSTMENTS
Revision of a currently approved collection   No
Regular
Approved without change 02/05/1985
Retrieve Notice of Action (NOA) 12/21/1984
APPROVED. AS HHS WILL NOT NEED THIS FORM AFTER DECEMBER 1986 (A PROJEC HHS IS CURRENTLY WORKING ON TO ADAPT THE WAGE REPORTING SYSTEM TO ACCE AND PROCESS ADJUSTMENTS FOR PERIODS BEFORE 1982 WILL BE COMPLETED) OMB APPROVAL IS ONLY THROUGH DECEMBER 1986.
  Inventory as of this Action Requested Previously Approved
12/31/1986 12/31/1986 03/31/1985
6,000 0 8,000
3,000 0 4,000
0 0 0

FORM SSA-3964 IS NEEDED AND USED BY STATE AND LOCAL ENTITIES TO REPORT CORRECTIONS TO WAGES OR TIPS PAID PRIOR TO 1981 WHICH WERE PREVIOUSLY REPORTED INCORRECTLY. THE AFFECTED PUBLIC IS COMPRISED OF THE ENTITIE REPORTING ON BEHALF OF CERTAIN OF THEIR EMPLOYEES.

None
None


No

1
IC Title Form No. Form Name
STATES REPORT OF ADJUSTMENTS SSA-3964, (10-80)

  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 6,000 8,000 0 -2,000 0 0
Annual Time Burden (Hours) 3,000 4,000 0 -1,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
12/21/1984


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