TN 15 (09-92)

RS 01403.016 Certification of Contents of Employer's Records


An authorized SSA employee may certify to the contents of the employer's records where the employer, representative of the employer, or the custodian of the records will not, or cannot, execute a statement but makes the records available to the authorized SSA employee.


Prepare a certification based on the employer's records on either a Form SSA-5002 (Report of Contact) or the RPOC screen for MCS claims (MSOM MCS 008.007).

The certification will show:

  • that the employer's records were examined;

  • that the certification was prepared from those records;

  • pertinent wage information contained in the employer's records (e.g., periods of employment, amounts, etc.);

  • the business name (and trade name, if any) and address of the employer;

  • the employer's Employer Identification Number (EIN);

  • the type of records examined; and

  • the reason for not obtaining the employer's or custodian's signed statement.

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RS 01403.016 - Certification of Contents of Employer's Records - 10/01/1998
Batch run: 07/03/2014