Application for Parent's Insurance Benefits 20 CFR 404.370, .371, .373, .374, .601-.603

Forms and Documents

Document Name	Status
Signature Proxy 83c Justifications 07-17-06-- FINAL[1].doc Justification for No Material/Nonsubstantive Change	2006-09-01

IC Document Collections

IC ID	Document Title	Status
8887	Application for Parent's Insurance Benefits / SSA-7-F6	Modified
45009	Application for Parent's Insurance Benefits / MCS	New
45008	Application for Parent's Insurance Benefits / Modernized Claims System (MCS) Signature Proxy	New

ICR Details

OMB Control No: 0960-0012	ICR Reference No: 200608-0960-021
Status: Historical Active	Previous ICR Reference No: 200602-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Parent's Insurance Benefits 20 CFR 404.370, .371, .373, .374, .601-.603
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/2006
	Date Received in OIRA: 09/01/2006
Terms of Clearance: OMB approves this burden reduction due to SSA's implementation of the Signature Proxy initiative.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2009	04/30/2009	04/30/2009
Responses	1,400	0	1,400
Time Burden (Hours)	339	0	350
Cost Burden (Dollars)	0	0	0

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Abstract: Form SSA-7-F6 collects information to entitle an individual to parent's insurance benefits. The respondents are individuals who wish to apply to receive parent's insurance benefits.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Application for Parent's Insurance Benefits / MCS
Application for Parent's Insurance Benefits / SSA-7-F6
Application for Parent's Insurance Benefits / Modernized Claims System (MCS) Signature Proxy

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ICR Summary of Burden

	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	1,400	1,400	0	0	0	0
Annual Time Burden (Hours)	339	350	0	-11	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The Application for Parent's Insurance Benefits is one of the collections cited under our ICB burden reduction initiative, Signature Proxy. The Signature Proxy Initiative is an alternative to the traditional pen and ink or “wet” signature, and it eliminates the need to retain paper applications in most circumstances by allowing the technician to process the application on the claimant’s behalf, without a signature. In most instances, Signature Proxy allows SSA to store and process the entire benefit application electronically, thus reducing costs associated with mailing and storing physical files. In addition, the adoption of Signature Proxy supports faster processing of claims and will improve service to the public by eliminating the need to mail the application to the claimant and wait for it to be signed and returned. Please see the attached Supplementary Documentation which outlines the burden savings achieved through this collection and all other application in the Signature Proxy Initiative.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/01/2006

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