Justification for the Non-Substantive Changes to 0960-0138 (Signature Removal)

Justification for Non-Substantive Changes for Form SSA-L4201

Letter to Employer Requesting Wage Information

20 CFR 416.203 & 416.1110

OMB No. 0960-0138

Background

The Social Security Administration (SSA) uses SSA uses the SSA-L4201 for the Supplemental Security Income (SSI) program to request wage information from employers when we are unable to verify wage information using preferred sources of wage information, such as pay slips or evidence from SSA-approved payroll data providers. Currently, the paper and PDF versions of this form requires the employer or payroll representative completing the form to provide a signature.

SSA recently reassessed the need for the respondent’s signature on this form and determined that we no longer require it. Therefore, we are removing the signature requirement from this form.

Revision to the Information Collection

• Change #1: SSA is removing the signature requirement from Form SSA-L4201. On pages 5 and 6 of the form, we have replaced the signature field with a field that requests the name of the employer or payroll representative completing the form.

Justification #1: We reassessed the need for a wet signature on this form and determined we no longer require it. Therefore, we will no longer ask respondents to sign this form prior to submitting it to SSA.

After OMB approves the signature removal for this form, we will implement the new version of the form that clarifies that we no longer require a signature by replacing the signature prompt with one that collects the respondent’s name.

This action will not affect the public reporting burden.