Request for Social Security Statement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-7004 Request for Social Security Statement (paper version)	Form	Modified	Available
Nonsubstantive change request 0466.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2012-03-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9352	Request for Social Security Statement--paper version	Form	Modified	Request for Social Security Statement (paper version)
180317	Request for Social Security Statement - Internet Version	Other-Internet Screens & Instrruction	Unchanged

ICR Details

OMB Control No: 0960-0466	ICR Reference No: 201203-0960-002
Status: Historical Active	Previous ICR Reference No: 201002-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Social Security Statement
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: 03/26/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/20/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2013	08/31/2013	08/31/2013
Responses	553,000	0	553,000
Time Burden (Hours)	46,083	0	46,083
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA collects information on Form SSA-7004 to identify respondents' Social Security earnings records, extract posted earnings informations, calculate potential benefit estimates, produce the resulting Social Security Statements and mail them to the requesters. Respondents are Social Security number holders requesting information about their Social Security earnings records and estimates of their potential benefits.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1320b-13 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 9992	03/04/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 29797	05/27/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Request for Social Security Statement - Internet Version
Request for Social Security Statement--paper version	SSA-7004	Request for Social Security Statement (paper version)

---

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	553,000	553,000	0	0	0	0
Annual Time Burden (Hours)	46,083	46,083	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:

---

Annual Cost to Federal Government: $152,400

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

---

Common Form ICR:  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:

(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: 03/20/2012

---