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Statement of Employer
Statement of Employer
OMB: 0960-0030
IC ID: 43689
OMB.report
SSA
OMB 0960-0030
ICR 202505-0960-001
IC 43689
( )
Documents and Forms
Document Name
Document Type
Form SSA-7011-F4
Statement of Employer
Form
SSA-7011-F4 Statement of Employer
SSA-7011-F4.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Statement of Employer
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 404.801-404.803
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-7011-F4
Statement of Employer
SSA-7011-F4.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
750
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
750
0
0
250
0
500
Annual IC Time Burden (Hours)
750
0
0
250
0
500
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
