Supporting Statement for Form SSA-7004
Request for Social Security Statement
20 CFR 404.810
OMB No. 0960-0466
A. Justification
Introduction/Authoring Laws and Regulations
Section 205(c)(2)(A) of the Social Security Act (Act) requires the Commissioner of the Social Security Administration (SSA) to establish and maintain records of wages paid to, and amounts of self-employment income derived by, each individual, as well as the periods in which such wages were paid and such income derived. In addition, upon request, the Commissioner must inform any individual or their survivor of the periods during which employers paid those wages, or an individual derived such income. Section 1143(a)(2) of the Act requires the Commissioner provide, upon the request of an eligible individual, a Social Security Statement (hereinafter referred to as Statement). 20 CFR 404.810 of the Code of Federal Regulations provides that an individual may make a written request to obtain a Statement of earnings or quarters of coverage, as shown in SSA records. SSA established Form SSA‑7004 to fulfill the “written request” requirement.
Description of Collection
SSA uses the information from Form SSA-7004 to identify a respondent’s Social Security earnings records; extracted posted earnings information; calculate potential benefit estimates; produce the resulting Social Security Statements; and mail them to the requestors. The respondents are Social Security number holders requesting information about their Social Security earnings records and estimates of their potential benefits.
Use of Information Technology to Collect the Information
An individual may complete and mail Form SSA-7004 to SSA to obtain a Statement of Earnings or Quarters of Coverage. SSA plans to create an electronic version of Form SSA‑7004 under the agency’s Government Paperwork Elimination Act (GPEA) plan as we have 60,026 respondents complete the form annually. However, other higher priority forms take precedence at this time.
Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it preclude duplication. SSA does not use another collection instrument to obtain similar data.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-7004, individuals would be unable to exercise their statutory right to submit a request for copies of their earnings or quarters of coverage as shown on SSA records. Because we only collect the information on an as‑needed basis, we cannot collect it less frequently. There are no technical or legal obstacles to burden reduction.
Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on June 4, 2019, at 84 FR 25891, and we received no public comments. The 30-day FRN published on August 13, 2019 at 84 FR 40121. If we receive any comments in response to this Notice, we will forward them to OMB.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden (based on FY 2018)
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Total Annual Burden (hours) |
SSA-7004 |
60,026 |
1 |
5 |
5,002 |
The total burden for this ICR is 5,002 hours. We based this figure on current management information data. This figure represents burden hours, and we did not calculate a separate cost burden.
Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $225,300. This estimate accounts for costs from the following areas: (1) designing, printing, and distributing the form; and (2) SSA employee (e.g., field office, 800 number, DDS staff) information collection and processing time.
Program Changes or Adjustments to the Information Collection Request
When we last cleared this IC in 2016, the burden was 3,341 hours. However, we are currently reporting a burden of 5,002 hours. This change stems an increase in the number of responses from 40,091 to 60,026. 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.
Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
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