Information Collection

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

IC 265219 under ICR 202412-0960-010 · OMB 0960-0837.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-L4201 0960-0138 - Letter to Employer Requesting Wage Information (SSA-L4201)	Form and Instruction
Form SSA-L4201 Letter to Employer Requesting Wage Information 0960-0138 - Letter to Employer Requesting Wage Information (SSA-L4201)	Form and Instruction
SSA-L4201 Letter to Employer Requesting Wage Information SSA-L4201.pdf	Form and Instruction
SSA-L4201 Letter to Employer Requesting Wage Information SSA-L4201.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-L4201			www.ssa.gov	No		Fillable Printable

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
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.

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