Statement of Employer

Statement of Employer

OMB: 0960-0030

IC ID: 43689

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Statement of Employer
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.801-404.803

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-7011-F4 Statement of Employer SSA-7011-F4 (revised).pdf No   Paper Only

Income Security General Retirement and Disability

 

500 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 500 0 0 0 0 500
Annual IC Time Burden (Hours) 167 0 0 0 0 167
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-7011 Current Version SSA-7011-F4 (revised).pdf 06/26/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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