FORM SSA-625 ELICITS INFORMATION FROM
STATE MENTAL FACLITIES WHICH HAVE SERVED AS REPRESENTATIVE PAYEE
AND ARE TERMINATING THIS SERVICE. THE INFORMATION COLLECTED PERMITS
SSA TO DETERMINE WHETHER THE FACILITY HAS USED THE FUNDS PROPERLY
AND TO CONFIRM WITH THE NEW PAYEE THAT FUNDS HAVE BEEN RECEIVED
FROM THE FORMER PAYEE.
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.