Letter to Employer Requesting Wage Information

OMB 0960-0138

SSA must establish and verify wage information for Supplemental Security Income (SSI) applicants and recipients when determining SSI eligibility and payment amounts. SSA uses Form SSA-L4201 to collect wage data from employers. SSA uses the information to determine eligibility and proper payment amounts for SSI applicants and recipients. The respondents are employers of SSI applicants and recipients.

The latest form for Letter to Employer Requesting Wage Information expires 2021-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-L4201 Letter to Employer Requesting Wage Information Form
Supporting Statement - 0138 (Final).docx Supporting Statement A
Addendum - 0138 (Final).docx Supplementary Document
Letter to Employer Requesting Wage Information Form

All Historical Document Collections

202011-0960-001 Approved with change	Revision of a currently approved collection	2021-03-15
201710-0960-004 Approved without change	Revision of a currently approved collection	2018-01-30
201504-0960-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-04-13
201409-0960-013 Approved without change	Revision of a currently approved collection	2014-12-09
201111-0960-017 Approved without change	Revision of a currently approved collection	2012-03-26
200901-0960-009 Approved without change	Revision of a currently approved collection	2009-05-15
200605-0960-001 Approved without change	Revision of a currently approved collection	2006-05-16
200305-0960-004 Approved without change	Extension without change of a currently approved collection	2003-05-27
200003-0960-005 Approved without change	Extension without change of a currently approved collection	2000-03-28
199702-0960-003 Approved without change	Extension without change of a currently approved collection	1997-02-26
199401-0960-001 Approved without change	Revision of a currently approved collection	1994-01-03
199105-0960-009 Approved with change	No material or nonsubstantive change to a currently approved collection	1991-05-07
199012-0960-001 Approved without change	Extension without change of a currently approved collection	1990-12-07
199005-0960-003 Approved without change	Revision of a currently approved collection	1990-05-07
198804-0960-001 Approved without change	Revision of a currently approved collection	1988-04-07
198512-0960-004 Approved without change	Revision of a currently approved collection	1985-12-27
198508-0960-039 Approved with change	No material or nonsubstantive change to a currently approved collection	1985-08-15
198212-0960-003 Approved without change	Revision of a currently approved collection	1982-12-07
198012-0960-003 Approved without change	Revision of a currently approved collection	1980-12-19
197902-0960-001 Approved without change	Revision of a currently approved collection	1979-02-26
197601-0960-008 Approved with change	No material or nonsubstantive change to a currently approved collection	1976-01-09
197601-0960-001 Approved without change	New collection (Request for a new OMB Control Number)	1976-01-09