Employer Verification of Earnings After Death

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-L4112 Employer Verification of Earnings After Death	Form	Modified	Available
Addendum - 0472.docx	Supporting Statement B	Uploaded 2026-10-29	Available
Supporting Statement - 0472 (final).docx	Supporting Statement A	Uploaded 2026-10-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9361	Employer Verification of Earnings After Death	Other-0960-0472 Revised Privacy Act Statement	Modified
9361	Employer Verification of Earnings After Death	Form	Modified	Employer Verification of Earnings After Death

ICR Details

OMB Control No: 0960-0472	ICR Reference No: 202610-0960-001
Status: Received in OIRA	Previous ICR Reference No: 202206-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Employer Verification of Earnings After Death
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/29/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	27,304	13,114
Time Burden (Hours)	18,203	4,371
Cost Burden (Dollars)	0	0

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Abstract: When SSA records show a wage earner is deceased, and we receive wage reports from an employer for the wage earner for a year subsequent to the year of death, SSA mails the employer Form SSA–L4112 (Employer Verification of Earnings After Death). SSA uses the information provided on Form SSA–L4112 to verify that the wage information previously received from the employer is correct for the employee and the year in question (the year following the employee’s death). This process helps ensure the accuracy and integrity of earnings records. The respondents are employers who report wages for employees who have died.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Evidence, Procedure, and Certification for Payments
   US Code: 42 USC 432 Name of Law: Processing of Tax Data
   US Code: 42 USC 409
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 55423	08/27/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 68213	10/29/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Employer Verification of Earnings After Death	SSA-L4112	Employer Verification of Earnings After Death

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ICR Summary of Burden

table that charts list 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	27,304	13,114	0	0	14,190	0
Annual Time Burden (Hours)	18,203	4,371	0	0	13,832	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: When we cleared the this ICR in 2023, the burden was 4,371 hours. However, we are currently reporting a burden of 9,101 hours. This change stems from an increase in the number of responses from 13,114 to 27,304. These figures represent current Management Information data. The availability of electronic management information data has enabled SSA to report a more accurate number of responses, resulting in an increase in the number of respondents for this renewal period. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. *Note: The total burden reflected in ROCIS is 18,203, while the burden cited in #12 of the Supporting Statement is 9,101. This discrepancy is because the ROCIS burden reflects the learning costs. In contrast, the chart in #12 above reflects actual burden.

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Annual Cost to Federal Government: $235,554

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.     Yes

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.     Yes

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

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Common Form ICR:  No

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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: 10/29/2026

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