Missing and Discrepant Wage Reports Letter and Questionnaire

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0432 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-95-SM Missing and Discrepant Wage Reports Letter and Questionnaire Form
SSA-L-94-SM 0813.doc Other-Cover Letter (Revised)
SSA-L-93-SM 0813 2.doc Other-Revised Cover Letter (mock-up
SSA-95-SM Employer Questionnaire--SSA Has No Record of Employer Re SSA-95-SM Revised Version.pdf Form
SSA-97-SM Employer Questionnaire--Discrepancy Between IRS and SSA SSA-97-SM Revised Version.pdf Form
SSA-L-93-SM 0610 (current).doc SSA-L-93-SM - (Cover Letter) IC Document
SSA-L-94-SM 0610 (Current).doc SSA-L-94-SM (Cover letter) IC Document
SSA-95-SM 2nd Req 0610 (current).doc SSA-95-SM- 2nd Request: -Employer Questionnaire- SSA has no record of employer report (current) IC Document
SSA-97-SM 2nd Req 0610 (current).doc SSA-97-SM Employer Questionnaire- Discrepancy Between IRS and SSA Records (current) IC Document
SSA-97-Second Request Revised Version.pdf SSA-97-Second Request Revised Version IC Document
SSA-95-Second Request Revised Version.pdf SSA-95 Second Request Revised Version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Missing and Discrepant Wage Reports Letter and Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 26 CFR 31.6051-2

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-95-SM	Employer Questionnaire--SSA Has No Record of Employer Report	SSA-95-SM Revised Version.pdf	No	Paper Only
Form	SSA-97-SM	Employer Questionnaire--Discrepancy Between IRS and SSA Records	SSA-97-SM Revised Version.pdf	No	Paper Only
Other-Cover Letter (Revised)			SSA-L-94-SM 0813.doc	No	Paper Only
Other-Revised Cover Letter (mock-up with changes)			SSA-L-93-SM 0813 2.doc	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 360,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	360,000	360,000
Annual IC Time Burden (Hours)	180,000	180,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-L-93-SM - (Cover Letter)	SSA-L-93-SM 0610 (current).doc	03/22/2011
SSA-L-94-SM (Cover letter)	SSA-L-94-SM 0610 (Current).doc	03/22/2011
SSA-95-SM- 2nd Request: -Employer Questionnaire- SSA has no record of employer report (current)	SSA-95-SM 2nd Req 0610 (current).doc	03/22/2011
SSA-97-SM Employer Questionnaire- Discrepancy Between IRS and SSA Records (current)	SSA-97-SM 2nd Req 0610 (current).doc	03/22/2011
SSA-97-Second Request Revised Version	SSA-97-Second Request Revised Version.pdf	12/20/2013
SSA-95 Second Request Revised Version	SSA-95-Second Request Revised Version.pdf	12/20/2013

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