Statement of Agricultural Employer (Year Prior to 1988; 1988 and Later)

Forms and Documents

Document Name	Status
Form SSA=1002 SSA-1002 Form	Modified
Form SSA-1003 SSA-1003 Form	New
Supporting Statement--0036.doc Supporting Statement A	2007-10-22

IC Document Collections

IC ID	Document Title	Status
8936	SSA-1002 Form	Modified
182041	SSA-1003 Form	New

ICR Details

OMB Control No: 0960-0036	ICR Reference No: 200709-0960-005
Status: Historical Active	Previous ICR Reference No: 200408-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement of Agricultural Employer (Year Prior to 1988; 1988 and Later)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2007
	Date Received in OIRA: 10/28/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2010	36 Months From Approved	12/31/2007
Responses	125,000	0	125,000
Time Burden (Hours)	62,500	0	62,500
Cost Burden (Dollars)	0	0	0

---

Abstract: The information from Forms SSA-1002-F3 and SSA-1003-F3 is used by SSA to resolve discrepancies when farm workers allege their employers did not report their wages, or reported the wages incorrectly. If an agricultural employer has incorrectly reported wages, or failed to report any wages for an employee, SSA must attempt to correct its records by contacting the employer to obtain convincing evidence of the wages paid. The respondents are agricultural employers having knowledge of wages paid to agricultural employees.

---

Authorizing Statute(s): US Code: 42 USC 409 Name of Law: null
   US Code: 42 USC 405 Name of Law: null
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 40353	07/24/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 59132	10/18/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
SSA-1002	SSA=1002	Statement of Agricultural Employer (Years Prior to 1988)
SSA-1003	SSA-1003	Statement of Agricultural Employer for Years 1988 and Later

---

ICR Summary of Burden

	Total Approved	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	125,000	125,000	0	0	0	0
Annual Time Burden (Hours)	62,500	62,500	0	0	0	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: Prior to ROCIS SSA had no way to separate the burdens for the two forms. Through ROCIS we can now separate them; therefore we created a new IC to do so. There is no change in the number of respondents or the Annual Burden Hours. The change that you see within the ICs themselves is due only to the way in which ROCIS processes ICs.

---

Annual Cost to Federal Government: $300,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 10/28/2007

---