Information Collection

SSA-L4002, Request for Employer Information

IC 178763 under ICR 201004-0960-004 · OMB 0960-0508.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0508 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-L4002 Request for Employer Information SSA-L4002, Request for Employer Information	Form
SSA-L4002 Request for Employer Information Revised SSA-L4002 (for use in 2010).pdf	Form
Current SSA-L4002 (2009).pdf Current SSA-L4002	IC Document

IC Title:

SSA-L4002, Request for Employer Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.120

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-L4002				No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 218,891

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions, Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	218,891	-437,109	656,000
Annual IC Time Burden (Hours)	36,482	-72,851	109,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-L4002		07/09/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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