Letter to Employer Requesting Information About Wages Earned by Beneficiary

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-L725 Letter to Employer Requesting Information About Wages Earned by Beneficary	Form	Unchanged	Available
SSA-L725-F3 - Revised Version.pdf	Supplementary Document	Uploaded 2010-11-05	Available
Justification for Non-Substantive Change - 0034.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2010-11-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8933	Letter to Employer Requesting Information About Wages Earned by Beneficiary 20 CFR 404.703, 404.801	Form	Unchanged	Letter to Employer Requesting Information About Wages Earned by Beneficary

ICR Details

OMB Control No: 0960-0034	ICR Reference No: 201011-0960-004
Status: Historical Active	Previous ICR Reference No: 200811-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Letter to Employer Requesting Information About Wages Earned by Beneficiary
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/17/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/25/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	06/30/2012	06/30/2012
Responses	150,000	0	150,000
Time Burden (Hours)	100,000	0	100,000
Cost Burden (Dollars)	0	0	0

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Abstract: Form SSA-L725 verifies and determines the wages earned by a beneficiary for specific months, so that SSA may determine correct benefit payments. SSA needs the information on the SSA-L725 to calculate the correct amount of benefits payable and to maintain an accurate record of earnings for the beneficiary. Respondents are small business employers. In this change request, we are removing the signature question from forms where they are not legally required.

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Authorizing Statute(s): US Code: 42 USC 403 Name of Law: Social Security Act
  

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:
	74 FR 4498	01/26/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 15808	04/07/2009
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Letter to Employer Requesting Information About Wages Earned by Beneficiary 20 CFR 404.703, 404.801	SSA-L725	Letter to Employer Requesting Information About Wages Earned by Beneficary

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ICR Summary of Burden

table that charts list 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	150,000	150,000	0	0	0	0
Annual Time Burden (Hours)	100,000	100,000	0	0	0	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:

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Annual Cost to Federal Government: $231,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 11/25/2010

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