Request for Social Security Statement

Forms and Documents

Document Name	Status
Form SSA-7004 Request for Social Security Statement--paper version Form	Modified
Supporting Statement--0466.doc Supporting Statement A	2007-07-02

IC Document Collections

IC ID	Document Title	Status
9352	Request for Social Security Statement--paper version Form	Modified
180317	Request for Social Security Statement--Internet Version Other-Internet Screens & Instrruction	New

ICR Details

OMB Control No: 0960-0466	ICR Reference No: 200705-0960-016
Status: Historical Active	Previous ICR Reference No: 200405-0960-015
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Social Security Statement
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: 09/04/2007
	Date Received in OIRA: 07/03/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2010	36 Months From Approved	08/31/2007
Responses	545,668	0	800,000
Time Burden (Hours)	45,473	0	66,667
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses the information the requestor provides on form SSA-7004 to identify his or her Social Security earnings record, extract posted earnings information, calculate potential benefit estimates, produce the resulting information about their Social Security earnings records and estimates of their potential benefits.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 1320b-13 Name of Law: null
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 14845	03/29/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 35293	06/27/2007
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Request for Social Security Statement--Internet Version
Request for Social Security Statement--paper version	SSA-7004	Request for Social Security Statement (paper version)

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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	545,668	800,000	0	0	-254,332	0
Annual Time Burden (Hours)	45,473	66,667	0	0	-21,194	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: There has been an adjustment in the public reporting burden. This usage estimate volume is considerably lower than the report issued on December 10, 2003 as we now have a more accurate number of respondents for this collection. The number of automatic annual Statements is constantly increasing. Further, more people are using the automatic online benefit calculators to estimate their potential benefits. Also, we have split the burden between two ICs in order to show the separate burdens for the paper and Internet versions of the form.

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Annual Cost to Federal Government: $175,521

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

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Common Form ICR:  No

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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: 07/03/2007

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