Information about Joint Checking/Savings Account

Forms and Documents

Document Name	Status
Form SA-2574 Information about Joint Checking/Savings Account--Paper Version Form and Instruction	Modified
Form SSA-2574 (MSSICS S Information About Joint Checking/Savings Account--MSSICS Version Form	New
Supporting Statement--0461.doc Supporting Statement A	2007-06-14

IC Document Collections

IC ID	Document Title	Status
9346	Information about Joint Checking/Savings Account--Paper Version Form and Instruction	Modified
180315	Information About Joint Checking/Savings Account--MSSICS Version Form	New

ICR Details

OMB Control No: 0960-0461	ICR Reference No: 200705-0960-015
Status: Historical Active	Previous ICR Reference No: 200405-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Information about Joint Checking/Savings Account
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/22/2007
	Date Received in OIRA: 06/15/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	36 Months From Approved	08/31/2007
Responses	200,000	0	200,000
Time Burden (Hours)	23,333	0	23,333
Cost Burden (Dollars)	0	0	0

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Abstract: The SSA-2574 is used to collect information when a Supplemental Security Income (SSI) applicant/recipient objects to the assumption that he/she owns all or part of the funds in a joint checking or savings account which bears his or her name. Information about the account is collected from both the SSI applicant/recipient and other accountholder(s). These statements regarding ownership are required to determine whether the account is a resource of the SSI claimant. The amount of resources a person owns is one of the factors considered in determining eligibility for SSI. Respondents are applicants and recipients of SSI and individuals who are joint owners of financial accounts with SSI applicants/recipients.

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Authorizing Statute(s): US Code: 42 USC 1382 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:
	72 FR 13851	03/23/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 32697	06/13/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Information About Joint Checking/Savings Account--MSSICS Version	SSA-2574 (MSSICS Screens)	Information About Joine Checking/Savings Accounts
Information about Joint Checking/Savings Account--Paper Version	SA-2574	Information About Joint Checking/Savings Accounts

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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	200,000	200,000	0	0	0	0
Annual Time Burden (Hours)	23,333	23,333	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: There have been no program changes or adjustments in this form, and there is no change in the public reporting burden. However, since ROCIS allows us to show the separate burdens for those respondents who use the paper version and those who use the Modernized SSI Claims System, we have created separate ICs to show these burdens. Before ROCIS, we were unable to effectively show these burdens separately within the clearance package.

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Annual Cost to Federal Government: $848,050

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: 06/15/2007

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