Child Relationship Statement

Forms and Documents

Document	Type	Status	Availability
Form SSA-2519 Child Relationship Statement	Form	Modified	Available
Supporting Statement--0116.doc	Supporting Statement A	Uploaded 0000-00-00	Repair queued
SSA-2519 (Current Form).pdf	Supplementary Document	Uploaded 2004-08-31	Available
Addendum--0116.doc	Supplementary Document	Uploaded 2006-11-02	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
9088	Child Relationship Statement	Form	Modified

ICR Details

OMB Control No: 0960-0116	ICR Reference No: 200701-0960-003
Status: Historical Active	Previous ICR Reference No: 200402-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Child Relationship Statement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/16/2007
	Date Received in OIRA: 02/28/2007
Terms of Clearance: OMB approves this revision consistent with SSA agreement in writing on 5/11/07. SSA will circulate a new instrument standardizing the form's terminology to use a single phrase for "worker" and separate the purpose of the form from the Privacy Notice.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2010	36 Months From Approved	05/31/2007
Responses	50,000	0	50,000
Time Burden (Hours)	12,500	0	12,500
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected on the SSA-2519 is used to help determine the entitlement of children to Social Security benefits under section 216(h)(3) of the Social Security Act (deemed child provision). Respondents are persons with knowledge of the relationship between the number holder and his/her alleged biological child who is filing for benefits.

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Authorizing Statute(s): US Code: 42 USC 416 Name of Law: null
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 75607	12/15/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 7107	02/14/2007
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Child Relationship Statement	SSA-2519	Child Relationship Statement

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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	50,000	50,000	0	0	0	0
Annual Time Burden (Hours)	12,500	12,500	0	0	0	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:

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Annual Cost to Federal Government: $77,000

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: 02/28/2007

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