SSA will submit
a copy of this form to OMB with the burden disclosure statement
printed on it when it is distributed for use.
Inventory as of this Action
Requested
Previously Approved
04/30/1992
04/30/1992
15,000
0
0
1,250
0
0
0
0
0
THE INFORMATION COLLECTED BY FORM
SSA-4112 IS NEEDED TO DETERMINE IF THE WAGES REPORTED TO THE SOCIAL
SECURITY ADMINISTRATION (SSA) ARE CORRECT AND SHOULD BE CREDITED TO
THE EMPLOYEE. THE AFFECTED PUBLIC CONSISTS OF EMPLOYERS WHO
REPORTED WAGES FOR EMPLOYEES WHO WERE ACCORDING TO SSA RECORDS,
DECEASED AT THE TIME THE WAGES WERE PAID.
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.