STATEMENT OF CARE AND RESPONSIBILITY FOR BENEFICIARY

ICR 198707-0960-002

OMB: 0960-0109

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
114707 Migrated
ICR Details
0960-0109 198707-0960-002
Historical Active 198408-0960-014
SSA
STATEMENT OF CARE AND RESPONSIBILITY FOR BENEFICIARY
Extension without change of a currently approved collection   No
Regular
Approved without change 09/17/1987
Retrieve Notice of Action (NOA) 07/16/1987
  Inventory as of this Action Requested Previously Approved
09/30/1990 09/30/1990 10/31/1987
130,000 0 130,000
21,667 0 21,667
0 0 0

THE INFORMATION COLLECTED BY FORM SSA-788 IS USED BY TH SOCIAL SECURITY ADMINISTRATION TO EVALUATE THE CONCERN THAT A POTENTIA PAYEE SHOWS TOWARD THE BENEFICIARY. THE AFFECTED PUBLIC CONSISTS OF INDIVIDUALS OR INSTITUTIONS WHO HAVE CUSTODY OF BENEFICIARY FOR WHOM SOMEONE ELSE HAS FILED TO BE REPRESENTATIVE PAYEE.

None
None


No

1
IC Title Form No. Form Name
STATEMENT OF CARE AND RESPONSIBILITY FOR BENEFICIARY SSA-788

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 130,000 130,000 0 0 0 0
Annual Time Burden (Hours) 21,667 21,667 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
07/16/1987


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