The information collected on Form
SSA-11-BK is used to determine the proper payee for a Social
Security beneficiary, and is designed to aid in the investigation
of a payee applicant. The form establishes the applicant's
relationship and concern for the beneficiary, and the manner in
which benefits will be used. The respondents are applicants for
representative payee for Old Age, Survivors and Disability
Insurance (OASDI), Supplemental Security Income (SSI) Black Lung
Benefits and Title-VII Special Veterans Benefits.
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.