Approved
consistent with memo dated 1/11/06. SSA agrees to change the
language on the SSA-11-BK form to conform with the language
regarding claimants' parole/ probation status as discussed in the
Nonpayment of Benefits NPRM (0960-AG12) recently approved by OMB.
Consistent with DOJ comments on the NPRM, the language on the form
should state the the claimant "is violating" a condition of
probation/ parole, not that they "have violated."
Inventory as of this Action
Requested
Previously Approved
01/31/2009
01/31/2009
08/31/2006
2,121,686
0
2,121,686
371,295
0
371,295
0
0
0
The information established by the
form is necessary to determine the proper payee for a Social
Security beneficiary. The form is designed to aid the investigation
of a payee applicant. The use of the form will establish the
applicant's relation to the beneficiary, his/her justification and
his/her concern for the beneficiary, as well as the manner in which
the benefits will be used. The respondents are applicants for
selection as representawtive payee for Title II, VIII, XVI and
Black Lung.
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.