Form Ssa-7050-F4 - Request For Social Security Earnings Information

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Form SSA-7050-F4 (10-2016) UF
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Discontinue prior editions
OMB No. 0960-0525
Social Security Administration
*Use This Form If You Need
1. Certified/Non-Certified Detailed Earnings Information
Includes periods of employment or self-employment
and the names and addresses of employers.
Yearly earnings totals are FREE to the public
if you do not require certification.
To obtain FREE yearly totals of earnings,
2. Certified Yearly Totals of Earnings
visit our website at
Includes total earnings for each year but does not
include the names and addresses of employers.
Privacy Act Statement
Collection and Use of Personal Information
Section 205 of the Social Security Act, as amended, authorizes us to collect the information on this form. We will
use the information you provide to identify your records and send the earnings information you request.
Completion of this form is voluntary; however, failure to do so may prevent your request from being processed.
We rarely use the information in your earnings record for any purpose other than for determining your entitlement
to Social Security benefits. However, we may use it for the administration and integrity of Social Security programs.
We may also disclose information to another person or to another agency in accordance with approved routine
uses, which include but are not limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights to Social Security
benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social Security records (e.g., to the
Government Accountability Office and Department of Veterans' Affairs);
3. To make determinations for eligibility in similar health and income maintenance programs at the Federal,
State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to assure the integrity and
improvement of Social Security programs.
A complete list of routine uses for earnings information is available in our Systems of Records Notices entitled, the
Earnings Recording and Self-Employment Income System (60-0059), the Master Beneficiary Record (60-0090),
and the SSA-Initiated Personal Earnings and Benefit Estimate Statement (60-0224).
In addition, you may choose to pay for the earnings information you requested with a credit card.
31 C.F.R. Part 206 specifically authorizes us to collect credit card information. The information you provide about
your credit card is voluntary. Providing payment information is only necessary if you are making payment by credit
card. You do not need to fill out the credit card information if you choose another means of payment (for example,
by check or money order). If you choose the credit card payment option, we will provide the information you give us
to the banks handling your credit card account and the Social Security Administration's (SSA) account.
Routine uses applicable to credit card information, include but are not limited to:
(1) to enable a third party or an agency to assist Social Security to effect a salary or an administrative offset or to
an agent of SSA that is a consumer reporting agency for preparation of a commercial credit report in accordance
with 31 U.S.C. §§ 3711, 3717 and 3718; and (2) to a consumer reporting agency or debt collection agent to aid in
the collection of outstanding debts to the Federal Government.
A complete list of routine uses for credit card information is available in our System of Records Notice entitled, the
Financial Transactions of SSA Accounting and Finance Offices (60-0231). The notice, additional information
regarding this form, routine uses of information, and our programs and systems is available on-line at
or at your local Social Security office.
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507,
as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions
unless we display a valid Office of Management and Budget control number. We estimate that it will take about 11
minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to
our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.


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