Supporting Statement 0525 (revised)

Supporting Statement for

Requests for Social Security Earnings Information

Form SSA-7050-F4

20 CFR 404.810, 20 CFR 401.100

OMB No. 0960-0525

1. Justification

1. Introduction/Authoring Laws and Regulations

The Social Security Administration (SSA) uses the Request for Social Security Earnings Information (Form SSA-7050-F4) for Social Security number (SSN) holders or their legal representative to request an Itemized Statement of Earnings (Form SSA-1826) for various non-program related reasons. Section 205(c)(2)(A) of the Social Security Act

(the Act) mandates the disclosure of earnings. Section 20 CFR 404.810 of the Code of Federal Regulations describes the information individuals need to must provide to obtain a statement of earnings and a benefit estimate statement. Section 20 CFR 401.100 describes the rules for disclosure of official records and information.

2. Description of Collection

The Social Security Act permits wage earners, or their authorized representative, to request Social Security earnings information from SSA using Form SSA-7050-F4. SSA uses the information to verify the requestor’s right to access the information and to produce the earnings statement. The respondents are wage earners and their authorized representatives. In addition, SSA requires proof of death or relationship if the request is for earnings information from a deceased person’s record. Such proof must support that a legal relationship exists between the requester and the SSN holder (i.e., surviving spouse, legal representative) so that SSA can access and subsequently disclose the requested information.

3. Use of Information Technology to Collect the Information

SSA did not create an electronic version of Form SSA-7054-F4 under the agency’s Government Paperwork Elimination Act (GPEA) plan because we require an original signature on Form SSA-7050, which prohibits respondents from completing and submitting the form electronically. In addition, the wage data we use to create the statement of earnings is data we receive and share with the Internal Revenue Service (IRS); thus is subject to IRS regulations regarding original signature requirements as well.

4. Why We Cannot Use Duplicate Information

The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to obtain similar data.

5. Minimizing Burden on Small Respondents

This collection does not significantly affect small businesses or other small entities.

6. Consequence of Not Collecting Information or Collecting it Less Frequently

If we did not use Form SSA-7050-F4, we would be denying the requester’s right to obtain such information, thus violating the above mandate. Because we only collect the information on an as needed basis, we cannot collect it less frequently.

There are no technical or legal obstacles to burden reduction.

7. Special Circumstances

There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.

8. Solicitation of Public Comment and Other Consultations with the Public

The 60-day advance Federal Register Notice published on February 10, 2014, at

79 FR 7736, and we received no public comments. The 30-day FRN published on

May 09, 2014 at 79 FR 26798. If we receive any comments in response to this Notice, we will forward them to OMB. We did not consult with the public in the revision of this form.

9. Payment or Gifts to Respondents

SSA does not provide payment or gifts to the respondents.

10. Assurances of Confidentiality

SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 422, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A‑130

11. Justification for Sensitive Questions

This information collection does not involve any questions of a sensitive nature.

12. Estimates of Public Reporting Burden

Modality of Completion	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Estimated Total Annual Burden (hours)
SSA-7050-F4	66,800	1	11	12,247

The total burden for this ICR is 12,247 hours. This figure represents burden hours, and we did not calculate a separate cost burden.

13. Annual Cost to the Respondents (Other)

Participating requesters must compensate SSA for non-program-related work so the Social Security Trust Funds do not bear the costs of such activities. Page 2 of the form provides the requester with a cost explanation and fee charge per request. The cost per non-certified respondent is $4,395,894. The cost per certified respondent is $3,121,932 ($7,517,826 per year total).

14. Annual Cost to Federal Government

The annual cost to the Federal Government is $245,773. This estimate is a projection of the costs for printing and distributing the form, and collecting the information.

15. Program Changes or Adjustments to the Information Collection Request

There has been an increase in burden hours, the increase stems from an increase in the number of respondents requesting earning information.

16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

17. Displaying the OMB Approval Expiration Date

OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.

18. Exceptions to Certification Statement

SSA is not requesting an exception to the certification requirement at 5 CFR 1320.9 and related provision at 5 CFR 1320.8 (b) (3).

2. Collections of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.