Internet Request for Replacement of Form SSA-1099/SSA-1042S

Forms and Documents

Document	Type	Status	Availability
Supporting Statement--0583.doc	Supporting Statement A	Uploaded 2006-10-05	Repair queued
Addendum--0583.doc	Supplementary Document	Uploaded 2006-09-18	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
9556	Internet Request for Replacement SSA-1099/1042S	Other-Internet Screens for Request for Replacement of Forms SSA-	Modified

ICR Details

OMB Control No: 0960-0583	ICR Reference No: 200609-0960-015
Status: Historical Active	Previous ICR Reference No: 200312-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Internet Request for Replacement of Form SSA-1099/SSA-1042S
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/28/2006
	Date Received in OIRA: 10/05/2006
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2009	36 Months From Approved	01/31/2007
Responses	21,000	0	21,000
Time Burden (Hours)	3,500	0	525
Cost Burden (Dollars)	0	0	0

---

Abstract: The information collected will be used by the Social Security Administration to verify identity and to provide replacement copies of Forms SSA-1099/SSA 1042S needed to prepare Federal tax returns. This Internet option to request a replacement SSA-1099/SSA-1042S will eliminate the need for a phone call to the national 800 number or a visit to a local field office. The respondents are beneficiaries who are requesting a replacement SSA-1099/SSA-1042S.

---

Authorizing Statute(s): US Code: 5 USC 552a(e)(10) & 552a(f)(2)-(3) Name of Law: Privacy Act of 1974
   US Code: 26 USC 6050F Name of Law: Internal Revenue Code
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 38681	07/07/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 58041	10/02/2006
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Internet Request for Replacement SSA-1099/1042S

---

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	21,000	21,000	0	0	0	0
Annual Time Burden (Hours)	3,500	525	0	0	2,975	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The change in burden information is due to an error in calculation which has now been corrected. SSA incorrectly sited the burden in the previous Supporting Statement as 1.5 minutes per response, when the correct burden is 10 minutes per response. Now that this discrepancy has been found, and the correction has been made, SSA has already made sure that the correct burden information is sited in the Supporting Statements of all Internet applications so that this will not happen again.

---

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

---

Common Form ICR:  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:

(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: 10/05/2006

---