THIS FORM IS NEEDED IN ORDER FOR A
DETERMANATION TO BE MADE REGARDING THE SUITABILITY OF A PAYEE FOR A
SOCIAL SECURITY BENEFICIARY WHO IS DETERMINED TO BE INCAPABLE OF
HANDLING HIS OWN FUNDS. OUR PROCEDURES REQUIRE THAT THE PAYEE
APPLICANT MUST SUBMIT EVIDENCE TO ESTABLISH HIS RELATIONSHIP TO, OR
HIS RESPONSIBILITY FOR THE CARE OF, THE BENEFICIARY. IN ORDER FOR A
DETERMINATION TO BE MADE ON THE SUITABILI OF A PAYEE, IS IS
NECCESSARY FOR THE APPLICANT TO FURNISH TH
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:
(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;
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.