Private Printing and Modification of Prescribed Application and Other Forms, 20 CFR 422.527

Forms and Documents

Document Name	Status
Form SSA-1010 Private Printing and Modification of Prescribed Application and Other Forms Form and Instruction	Modified
0663 supporting statement (final rules).doc Supporting Statement A	2007-12-28

IC Document Collections

IC ID	Document Title	Status
9711	Private Printing and Modification of Prescribed Application and Other Forms Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0663	ICR Reference No: 200712-0960-007
Status: Historical Active	Previous ICR Reference No: 200512-0960-012
Agency/Subagency: SSA	Agency Tracking No:
Title: Private Printing and Modification of Prescribed Application and Other Forms, 20 CFR 422.527
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: 02/21/2008
	Date Received in OIRA: 01/07/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2011	36 Months From Approved	03/31/2009
Responses	324	0	324
Time Burden (Hours)	43	0	43
Cost Burden (Dollars)	0	0	0

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Abstract: Regulation 20 CFR 422.527 states that any person, institution, or organization wishing to privately reproduce, duplicate, or print any of SSA's applications (such as forms) must first obtain written approval from the Administration to do so. The respondent are persons or organizations wishing to privately reproduce or print any of SSA's applications.

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Authorizing Statute(s): US Code: 42 USC 1320b–10 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0960-AG36	Final or interim final rulemaking	72 FR 73260	12/27/2007

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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: 1

IC Title	Form No.	Form Name
Private Printing and Modification of Prescribed Application and Other Forms	SSA-1010	Request to Reproduce, Reprint, or Distribute SSA Forms, Applications, or other Publications

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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	324	324	0	0	0	0
Annual Time Burden (Hours)	43	43	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: $194

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: 01/07/2008

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