OMB No. 0960-0030
A. Justification
Introduction/Authoring Laws and Regulations
Section 205(c)(2)(A) of the Social Security Act (Act) charges the Commissioner with establishing and maintaining records of the amounts of wages paid to, and the amounts of self-employment income derived by individuals. Section 205(d) of the Act provides the authority for the Social Security Administration (SSA) to issue a subpoena if an employer refuses to furnish the requested information. Regulations at 20 CRF 404.801- 404.802 of the Code of Federal Regulations describe the procedures SSA uses to implement section 205(c)(2)(A) of the Act. 20 CFR 404.803 explains that we may use our records and other evidence, such as a statement from an employer, to substantiate the amounts of earnings credited to an individual.
Description of Collection
SSA uses Form SSA–7011–F4 to substantiate allegations of wages paid to workers when those wages do not appear in SSA’s records of earnings and the worker does not have proof of those earnings. SSA uses the information to process claims for Social Security benefits and to resolve discrepancies in the individual’s Social Security earnings record. We only send Form SSA–7011–F4 to employers if we deem it necessary; in situations where we are unable to locate the earnings information within our records and have to contact the employer. The respondents are employers who can verify wage allegations made by wage earners.
Use of Information Technology to Collect the Information
Due to limited resources and agency priorities to convert higher-volume forms to electronic media before we work on lower-volume forms, this form is available electronically via the Intranet for field office use under the Government Paperwork Elimination Act.
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.
Minimizing Burden on Small Respondents
This collection does not significantly affect small businesses or other small entities. Per SSA’s policy, we do not to request wage data from an employer unless the individual is unable to furnish wage evidence. This minimizes the burden on small businesses.
Consequence of Not Collecting Information or Collecting it Less Frequently
If SSA did not conduct the information collection, it could result in incorrect payments or incorrect denials of benefits to the public. Since we only collect this information when we need to verify or correct the earnings record, 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.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on May 27, 2015, at 80 FR 30316, and we received no public comments. SSA published the second Notice on September 4, 2015 at 80 FR 53608. If we receive comments in response to the 30-day Notice, we will forward them to OMB. We did not consult with the public in the revision of this form.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
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-7011-F4 |
500 |
1 |
20 |
167 |
The total burden for this ICR is 167 hours. This figure represents burden hours, and we did not calculate a separate cost burden
Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $1,000,000. This estimate is a projection of the costs for printing and distributing the collection instrument.
Program Changes or Adjustments to the Information Collection Request
The reduction in burden hours stems from a decrease in the number of respondents. In addition, employers’ increase use of electronic reporting during the Annual Wage reporting process increased the speed at which SSA posts earnings, and recognizes and corrects errors in employer reports. Consequently, the incidence of erroneous postings on SSA’s earnings records substantially decreased within the past three years. Finally, within the past several years, SSA streamlined development requirements for identifying and resolving potential earnings errors when an individual contacts SSA alleging incorrect earnings on their record. As a result, we decreased the use of Form SSA-7011-F4.
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.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/msword |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| Last Modified By | 889123 |
| File Modified | 2015-09-08 |
| File Created | 2015-06-03 |