Statement of Employer

Documents and Forms

Document Name Document Type
Form SSA-7011-F4 Statement of Employer Form
SSA-7011-F4 Statement of Employer SSA 7011 (revised).pdf Form
SSA 7011 (current).pdf Statement of Employer IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Employer	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 404.801-404.803

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7011-F4	Statement of Employer	SSA 7011 (revised).pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Statement of Employer	SSA 7011 (current).pdf	01/08/2025

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