0960-0138 - Letter to Employer Requesting Wage Information (SSA-L4201)

Changes to the Use of Electronic Payroll Data to Improve Program Administration

Documents and Forms

Document Name Document Type
Form SSA-L4201 0960-0138 - Letter to Employer Requesting Wage Information (SSA-L4201) Form and Instruction
SSA-L4201 Letter to Employer Requesting Wage Information SSA-L4201.pdf www.ssa.gov Form and Instruction
SSA-L4201 Letter to Employer Requesting Wage Information SSA-L4201.pdf www.ssa.gov Form and Instruction

Information Collection (IC) Details

IC Title:	0960-0138 - Letter to Employer Requesting Wage Information (SSA-L4201)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 703(a)&(b) 20 CFR 404.1588(b)(3)(iii) & (b)(4) 20 CFR 416.708(c) 20 CFR 416.709 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-L4201	Letter to Employer Requesting Wage Information	SSA-L4201.pdf	www.ssa.gov	No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 133,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	133,000	133,000
Annual IC Time Burden (Hours)	66,500	66,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.