Letter to Employer Requesting Wage Information

ICR 200605-0960-001

OMB: 0960-0138

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
9117 Migrated
ICR Details
0960-0138 200605-0960-001
Historical Active 200305-0960-004
SSA
Letter to Employer Requesting Wage Information
Revision of a currently approved collection   No
Regular
Approved without change 07/07/2006
Retrieve Notice of Action (NOA) 05/16/2006
  Inventory as of this Action Requested Previously Approved
07/31/2009 07/31/2009 07/31/2006
133,000 0 133,000
66,500 0 66,500
0 0 0

The information collected on Form SSA-L4201 is used by SSA to collect wage information from employers to establish and/or verify wage information for Supplemental Security Income (SSI) claimants and recipients. Form SSA-L4201 is also used to determine eligibility and proper payment for SSI applicants/recipients. The respondents are employers of applicants and recipients of SSI payments.

None
None


No

1
IC Title Form No. Form Name
Letter to Employer Requesting Wage Information SSA-L4201

  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 133,000 133,000 0 0 0 0
Annual Time Burden (Hours) 66,500 66,500 0 0 0 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.
05/16/2006


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