Coverage of Employees of State and Local Governments

Forms and Documents

Document	Type	Status	Availability
Supporting Statement - 0425 (Final).docx	Supporting Statement A	Uploaded 2025-03-13	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
187832	20 CFR 404.1216 Modification of Agreement to Correct an Error	Other-Original Agrement Example	Modified
187831	20 CFR 404.1215 Modification of Agreement	Other-Original Agrement Example	Modified
187829	20 CFR 404.1204 Designating Officials to Act on Behalf of the State	Other-Original Agrement Example	Modified

ICR Details

OMB Control No: 0960-0425	ICR Reference No: 202411-0960-010
Status: Received in OIRA	Previous ICR Reference No: 202104-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Coverage of Employees of State and Local Governments
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/13/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2025
Responses	156	156
Time Burden (Hours)	130	130
Cost Burden (Dollars)	0	0

---

Abstract: The Code of Federal Regulations at 20 CFR 404 prescribe the rules for States submitting reports of deposits and related record keeping to SSA. States are required to provide wage information and deposit- related contribution information for pre-1987 periods. The respondents are State and local governments. We are submitting this extension request to extend the current information collection without changes to the currently approved collection (as a note, this information collection is for CFR citations which we have not changed over the past three years).

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 902 Name of Law: Social Security Act
   US Code: 42 USC 418 Name of Law: Social Security Act
   US Code: 42 USC 410 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:
	89 FR 97155	12/06/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 11771	03/11/2025
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
20 CFR 404.1204 Designating Officials to Act on Behalf of the State
20 CFR 404.1215 Modification of Agreement
20 CFR 404.1216 Modification of Agreement to Correct an Error

---

ICR Summary of Burden

	Total Request	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	156	156	0	0	0	0
Annual Time Burden (Hours)	130	130	0	0	0	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:

---

Annual Cost to Federal Government: $978,280

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.     No

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.     No

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? No

---

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: 03/13/2025

---