THE INFORMATION COLLECTED BY THIS FORM
IS NEEDED TO SUBSTANTIATE ALLEGATIONS OF WAGES PAID TO WORKERS WHEN
THOSE WAGES DO NOT APPEAR IN SSA'S RECORDS OF EARNINGS AND THE
WORKER DOES NOT HAVE PROOF THAT THEY WERE PAID. THIS INFORMATION IS
USED TO PROCESS CLAIMS FOR SOCIAL SECURITY BENEFITS AND TO RESOLVE
DISCREPANCIES IN EARNINGS RECORDS. T AFFECTED PUBLIC CONSISTS OF
CERTAIN EMPLOYERS FOR WHOM WAGES ARE ALLEG
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.