Request for Social Security Statement

Forms and Documents

Document Name	Status
Form SSA-7004 Request for Social Security Statement--paper version Form	Modified
Addendum - 0466.docx Supplementary Document	2016-09-02
Supporting Statement - 0466.docx Supporting Statement A	2016-09-02

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- On Hold Other-Internet Screens & Instrruction	Unchanged

ICR Details

OMB Control No: 0960-0466	ICR Reference No: 201606-0960-003
Status: Historical Active	Previous ICR Reference No: 201302-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Social Security Statement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/13/2016
	Date Received in OIRA: 09/02/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2019	36 Months From Approved	10/31/2016
Responses	40,091	0	2
Time Burden (Hours)	3,341	0	1
Cost Burden (Dollars)	0	0	0

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Abstract: SSA collects information on Form SSA-7004 to identify respondents' Social Security earnings records, extract posted earnings information, calculate potential benefit estimates, produce the resulting Social Security Statements and mail them to the requesters. Respondents are Social Security number holders requesting 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: Social Security Act
   US Code: 42 USC 1320b-13 Name of Law: Social Security Act
  

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:
	81 FR 39990	06/20/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 59261	08/29/2016
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- On Hold
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	40,091	2	0	40,089	0	0
Annual Time Burden (Hours)	3,341	1	0	3,340	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The decrease in the burden hours stems from increased online statement requests which people with my Social Security accounts make online. Since my SSA users need not fill out the SSA-7004, we do not count these request here. This form pertains to requests that people download, print, complete, and mail to SSA only.

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Annual Cost to Federal Government: $19,115

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 09/02/2016

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