Employer Verification of Earnings After Death

Employer Verification of Earnings After Death

OMB: 0960-0472

IC ID: 9361

Information Collection (IC) Details

View Information Collection (IC)

Employer Verification of Earnings After Death
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.822 20 CFR 404.821

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-L4112 Employer Verification of Earnings After Death SSA-L4112 (revised).pdf No   Paper Only

Income Security General Retirement and Disability

 

54,998 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 54,998 0 0 0 0 54,998
Annual IC Time Burden (Hours) 9,166 0 0 0 0 9,166
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-L4112 SSA-L4112 (current).pdf 11/25/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy