APPROVED WITH
THE CONDITIN THAT A COPY OF THE SSA INSTRUCTIONS DROPPING THE USE
OF THIS FORM IN REDETERMINATION CASES BE SUBMITTED FOR THE OMB
FILE.
Inventory as of this Action
Requested
Previously Approved
03/31/1985
03/31/1985
05/31/1984
650,000
0
1,500,000
65,000
0
150,000
0
0
0
THE INFORMATION COLLECTED ON FORM
SSA-4641 PROVIDES FINANCIAL INSTITUTIONS WITH THE CUSTOMER'S
AUTHORIZATION TO DISCLOSE RECORDS AS REQUIRED BY P.L. 95-630.
RESPONSES TO THE QUESTIONS ASKED ARE USED, IN PART, TO DETERMINE
WHETHER RESOURCE REQUIREMENTS ARE MET IN THE SUPPLEMENTAL SECURITY
INCOME AND AID TO FAMILIES WITH DEPENDENT CHILDREN
PROGRAMS.
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.