Statement of Care and Responsibility for Beneficiary, 20 CFR 404.2020, .2025, 408.620, .625, 416.620, .625

ICR 200606-0960-009

OMB: 0960-0109

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0960-0109 200606-0960-009
Historical Active 200308-0960-006
SSA
Statement of Care and Responsibility for Beneficiary, 20 CFR 404.2020, .2025, 408.620, .625, 416.620, .625
Extension without change of a currently approved collection   No
Regular
Approved with change 08/11/2006
Retrieve Notice of Action (NOA) 06/14/2006
Approved consistent with memo dated 8/11/06.
  Inventory as of this Action Requested Previously Approved
08/31/2009 36 Months From Approved 10/31/2006
130,000 0 130,000
21,667 0 21,667
0 0 0

Form SSA-788 is used to obtain information from the beneficiary's custodian about the representative payee applicant's concern and responsibility for the beneficiary. The respondents are individuals who have custody of the beneficiary where someone else has filed to be the beneficiary's representative payee.

None
None


No

1
IC Title Form No. Form Name
Statement of Care and Responsibility for Beneficiary, 20 CFR 404.2020, .2025, 408.620, .625, 416.620, .625 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.
06/14/2006


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