Forms Catalog Document - SSA7011 :-: SSA :-: Statement of Employer

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Statement of Employer

The information collected on Form SSA-7011 is needed by SSA to substantiate allegations of wages paid to workers when those wages do not appear on the SSA earnings record and the worker does not have proof that payment was made. This information is used to process claims for Social Security benefits and to resolve discrepancies in earnings records. The respondents are certain employers who can verify allegations of wages made by the wage earner.

Form #: SSA 7011 F4
Agency: Social Security Administration

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Both Form and Instructions	4		[1] Paper Only	Other Client Software

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