Letter to Employer Requesting Wage Information

Letter to Employer Requesting Wage Information

OMB: 0960-0138

IC ID: 9117

Documents and Forms
Document Name
Document Type
Form
Form
Other-SSI Wage Screens
Other-SSI Wage Screens
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Letter to Employer Requesting Wage Information
 
No Modified
 
Voluntary
 
20 CFR 416.203 20 CFR 416.1110

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-L4201 Letter to Employer Requesting Wage Information SSA-L4201 - Revised Version.pdf No   Fillable Printable
Other-SSI Wage Screens SSI Wage Screens.docx No   Fillable Printable

Income Security General Retirement and Disability

 

133,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 133,000 0 0 0 0 133,000
Annual IC Time Burden (Hours) 66,500 0 0 0 0 66,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-L4201 - Current Version SSA-L4201 - Current Version.pdf 05/09/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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