Letter to Employer Requesting Wage Information

SSA bases an individual’s eligibility for SSI payments, in part, on the amount of countable income the individual receives. We consider earned income from employment as a source of countable income. SSA applicants and recipients are required to provide evidence in support of their claims, but SSA will assist in collecting the required evidence when necessary. SSA uses Form SSA-L4201 for wage verification in initial and post-entitlement claims; the form collects current and past wage data directly from employers. We only use the SSA-L4201 when our efforts to obtain preferred evidence are unsuccessful. SSA uses the information collected to determine eligibility and proper payment amounts for SSI. Respondents are employers of SSI applicants and recipients. We are submitting a Change Request to remove the signature requirement from this form.

The latest form for Letter to Employer Requesting Wage Information expires 2026-08-31 and is listed under ICR 202405-0960-002.

View the official OMB control history on Reginfo.gov.