Information Collection

SSA-L4201 - Letter to Employer Requesting Wage Information

IC 9117 under ICR 202605-0960-006 · OMB 0960-0138.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-L4201 Letter to Employer Requesting Wage Information SSA-L4201 - Letter to Employer Requesting Wage Information	Form
SSI Wage Screens.docx	Other-SSI Wage Screens
SSA-L4201 Letter to Employer Requesting Wage Information SSA-L4201.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.1110 20 CFR 416.203

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	SSA-L4201				No		Fillable Printable
Other-SSI Wage Screens					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: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	133,000	0	133,000
Annual IC Time Burden (Hours)	77,583	11,083	66,500
Annual IC Cost Burden (Dollars)	0	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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