Form SSA-L3231-C1 Employer Verification of Records for Children Under Age

Form Approved

OMB No. 0960-0505

Social Security Administration
Retirement, Survivors, and Disability Insurance
Request for Employer Information
Social Security Administration
Data Operations Center
P.O. Box 39
Wilkes Barre, PA 18767-0039

•

Date:
Sequence Number:
Employer Number:
We are writing to you about your Form W-2, Wage and Tax Statement, for the employee

shown below. Our records show that the employee is a young child. Therefore, we need

your help to resolve some questions before we can add the wages to the employee's earnings

record.

Employee's Name:

Social Security Number:

Reported Earnings:

Tax Year:

Please fill in the information on the back of this form and mail it to us in the enclosed

envelope. If possible, verify the number on the employee's Social Security card and check

your records to give us the information requested.

If you have any questions, you may call us toll-free at 1-800-772-6270 from 7:00 a.m. to

7:00 p.m. Eastern Standard Time.
W. Burnell Hurt
Associate Commissioner
for Central Operations

Enclosure:
Envelope

SPrinted on recycled paper

(See Reverse)

Form SSA·L3231-Cl (4-99)
Use Prior Editions

Page 2

Social Security Request for Employee Information
1. Please print the full name as shown on the Social Security card:

--.lID L--I_ _ _ _

Name:lL.--_ _
FIRST

---I

M.I.

LAST

2. Enter the Social Security number from your records:

1I 'I-OJ-I 1 1 1 1
3. Enter the employee's date of birth: OJ OJ OJ and Sex DD
Social.Security'Number:1

Month

Day

Year

M

F

4. What is the latest address you have on file?

5.

What was the employee's job?

The Privacy ActJPaperwork Reduction Act Statement
Section 205(a) of the Social Security Act allows us to ask for the information on this letter. The
information you give us will be used to give the employee credit for the correct amount of wages.
You do not have to complete this letter, however, if you don't, we can't give the employee credit
for the correct amount of wages.
We may give this information to the Internal Revenue for tax administration purposes or to the
Department of Justice for investigating and prosecuting violations of the Social Security Act.
Explanations about these and other reasons why information you provide us may be used or
given out are available in Social Security offices. If you want to learn more about this, contact
any Social Security office.
PAPERWORK REDUCTION ACT NOTICE AND TIME IT TAKES STATEMENT
The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is
in accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of
1995. We may not conduct or sponsor, and you are not required to respond to, a collection of
information unless it displays a valid OMB control number. We estimate that it will take you
about 10 minutes to complete this form. This includes the time it will take to read the
instructions, gather the necessary facts and fill out the form.

See Revised Privacy Act and PRA Statements Attached

Form SSA-L3231-Cl (4-99)

SSA will insert the following revised Privacy Act and PRA Statements into the form at
its next scheduled reprinting:
Privacy Act Statement
Collection and Use of Personal Information
Section 205(a) of the Social Security Act, as amended, authorizes us to collect this
information. We will use the information you provide on this form to give the employee
credit for the correct amount of wages.
Completion of this form is voluntary, however, failure to provide all or part of the
information could prevent us from giving the employee credit for the correct amount of
wages.
We rarely use this information you supply for any purpose other than for determining
continuing eligibility. However, we may use it for the administration and integrity of
Social Security programs. We may also disclose information to another person or to
another agency in accordance with approved routine uses, which include but are not
limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights
to Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office and Department
of Veterans’ Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to
assure the integrity and improvement of Social Security programs.
We may also use the information you provide in computer matching programs. Matching
programs compare our records with records kept by other Federal, State, or local
government agencies. Information from these matching programs can be used to
establish or verify a person’s eligibility for Federally-funded or administered benefit
programs and for repayment of payments or delinquent debts under these programs.
Additional information regarding this form, routine uses of information, and our
programs and systems is available on-line at www.socialsecurity.gov or at your local
Social Security office.

Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 10
minutes to read the instructions, gather the facts, and answer the questions. Send only
comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401