Current SSA-L3231-C1

3231-11
RETURN THE ORIGINAL - NOT A COPY

Form Approved
OMB No. 0960-0505

Social Security Administration
Retirement, Survivors, and Disability Insurance
Request for Employer Information

Social Security Administration
Data Operations Center
P.O. Box 40
Wilkes Barre, PA 18767-0040
Date:
Sequence Number:
Employer Number:
We are writing to you about your Form W-2, Wage and Tax Statement, for the
employee shown below. Our records show that the employee is a young child.
Therefore, we need your help to resolve some questions before we can add the wages
to the employee's earnings record.
Employee's Name:
Social Security Number:
Reported Earnings:
Tax Year:
Please fill in the information on the back of this form and mail it to us in the
enclosed envelope. If possible, verify the number on the employee's Social Security
card and check your records to give us the information requested.
If you have any questions, you may call us toll free at 1-800-772-6270 from 7:00 a.m.
to 7:00 p.m. Eastern Time. If you are deaf or hard of hearing, you may call our TTY
number, 1-800-325-0778.

Enclosure:
Envelope

(Please See Reverse)

Form SSA-L3231 (10-2011)

3231-11
RETURN THE ORIGINAL - NOT A COPY

Page 2

Social Security Request for Employee Information
1.

Please print the full name as shown on the Social Security card:
Name:
First

2.

M.I.

Last

Enter the Social Security number from your records:
Social Security Number:

3.

Enter the employee's date of birth:

and Sex
Month

4.

What is the latest address you have on file?

5.

What was the employee's job?

Day

Year

M

F

Privacy Act Statement
Collection and Use of Personal Information
Section 205(a) of the Social Security Act, as amended, authorizes us to collect this information. We use the
information you provide on this form to give the employee credit for the correct amount of wages.
Completion of this form is voluntary. However, failure to provide all or part of the information could prevent
us from giving the employee credit for the correct amount of wages.
We rarely use this information you supply for any purpose other than for determining continuing eligibility.
However, we may use it for the administration and integrity of the Social Security programs. We may also
disclose information to another person or to another agency in accordance with approved routine uses,
which include but are not limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights to Social Security
benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social Security records (e.g., to
the Government Accountability Office and Department of Veterans' Affairs);
3. To make determinations for eligibility in similar health and income maintenance programs at the
Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to ensure the integrity
and improvement of Social Security programs.
We may also use the information you provide in computer matching programs. Matching programs compare
our records with records kept by other Federal, State, or local government agencies. Information from
these matching programs can be used to establish or verify a person's eligibility for Federally-funded or
administered benefit programs and for repayment of payments or delinquent debts under these programs.
Additional information regarding this form, routine uses of information, and our programs and systems is
available on-line at www.socialsecurity.gov or at your local Social Security office.

Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the
Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 10 minutes to read the
instructions, gather the facts, and answer the questions.
You may send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.
Send only comments relating to our time estimate to this address, not the completed form.

Form SSA-L3231

(10-2011)