Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100

Forms and Documents

Document Name	Status
Form SSA-7050-F4 Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100 Form	Modified
SSA-7050 SS 2007.doc Supporting Statement A	2008-01-08

IC Document Collections

IC ID	Document Title	Status
9428	Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100 Form	Modified

ICR Details

OMB Control No: 0960-0525	ICR Reference No: 200711-0960-001
Status: Historical Active	Previous ICR Reference No: 200411-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/02/2008
	Date Received in OIRA: 01/20/2008
Terms of Clearance: This information collection request is approved as submitted. OMB encourages SSA to explore the legality and feasibility of implementing electronic signature for this form which would allow it to be completed electronically and report to OMB on its assessment with the next submission of this collection for approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved	04/30/2008
Responses	60,000	0	87,000
Time Burden (Hours)	11,000	0	15,950
Cost Burden (Dollars)	0	0	0

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Abstract: The information on Form SSA-7050 is used by SSA to verify that the wage earner is authorized to access the correct earnings record in order to produce the earnings statement and to credit payment when payment is made by credit card. Respondents of Form SSA-7050 can be beneficiaries, and/or various private or public organizations or agencies.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 62510	11/05/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 1253	01/07/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request for Social Security Earnings Information, 20 CFR 404.810, 20 CFR 401.100	SSA-7050-F4	Request fo Social Security Earning Information

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ICR Summary of Burden

	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	60,000	87,000	0	0	-27,000	0
Annual Time Burden (Hours)	11,000	15,950	0	0	-4,950	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The annual reporting burden has been adjusted because of a decrease in the number of individuals requesting earnings information.

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Annual Cost to Federal Government: $184,800

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/20/2008

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