Request for Social Security Statement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-7004 Request for Social Security Statement--paper version	Form	Modified	Available
Addendum - 0466.docx	Supplementary Document	Uploaded 2019-08-14	Available
Supporting Statement - 0466.docx	Supporting Statement A	Uploaded 2019-08-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9352	Request for Social Security Statement--paper version	Form	Modified
180317	Request for Social Security Statement - Internet Version- On Hold	Other-Internet Screens & Instrruction	Removed

ICR Details

OMB Control No: 0960-0466	ICR Reference No: 201905-0960-001
Status: Active	Previous ICR Reference No: 201606-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Social Security Statement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/29/2019
	Date Received in OIRA: 08/19/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2022	36 Months From Approved	10/31/2019
Responses	60,026	0	40,091
Time Burden (Hours)	5,002	0	3,341
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA collects information on Form SSA-7004 to identify respondents' Social Security earnings records; extract posted earnings information; calculate potential benefit estimates; produce the resulting Social Security Statements, and mail them to the requesters. Respondents are Social Security number holders requesting information about their Social Security earnings records and estimates of their potential benefits.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1320b-13 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 25891	06/04/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 40121	08/13/2019
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Request for Social Security Statement - Internet Version- On Hold
Request for Social Security Statement--paper version	SSA-7004	Request for Social Security Statement (paper version)

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	60,026	40,091	0	0	19,935	0
Annual Time Burden (Hours)	5,002	3,341	0	0	1,661	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2016, the burden was 3,341 hours. However, we are currently reporting a burden of 5,002 hours. This change stems an increase in the number of responses from 40,091 to 60,026. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change.

---

Annual Cost to Federal Government: $225,300

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/19/2019

---