State Mental Institution Policy Review, 404.2035, .2065, 416.635, .665

Forms and Documents

Document	Type	Status	Availability
Form SSA-9584-BK State Mental Institution Policy Review	Form	Modified	Repair queued
Supporting Statement--0110.doc	Supporting Statement A	Uploaded 2008-02-04	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
9081	State Mental Institution Policy Review	Form	Modified

ICR Details

OMB Control No: 0960-0110	ICR Reference No: 200712-0960-009
Status: Historical Active	Previous ICR Reference No: 200501-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: State Mental Institution Policy Review, 404.2035, .2065, 416.635, .665
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: 03/26/2008
	Date Received in OIRA: 02/06/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2011	36 Months From Approved	03/31/2008
Responses	95	0	100
Time Burden (Hours)	95	0	100
Cost Burden (Dollars)	0	0	0

---

Abstract: The respondents are State mental institutions which serve as representative payees. The information collected by Form SSA-9584-BK is used by SSA to determine whether an institution’s policies and practices conform with SSA’s regulations in the use of benefits and whether the institution is performing other duties and responsibilities required of a representative payee. The information also provides a basis for conducting an onsite review of the institution and is used in the preparation of the subsequent report of findings. The respondents are State mental institutions which serve as representative payees for Social Security beneficiaries and SSI claimants.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 1383 Name of Law: null
  

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:
	72 FR 62510	11/05/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 3307	01/17/2008
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
State Mental Institution Policy Review	SSA-9584-BK	State Mental Instintution Policy Review

---

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	95	100	0	0	-5	0
Annual Time Burden (Hours)	95	100	0	0	-5	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 has been a decrease in the public reporting burden. Form SSA-9584 previously had 100 respondents which required 100 hours for completion. The number of State institutions participating in the onsite review program has declined in recent years. At this time there are approximately 285 State institutions participating in the onsite review program. These facilities are reviewed triennially with one-third reviewed each year. This is why the number has decreased to 95 respondents and 95 hours required for completion annually.

---

Annual Cost to Federal Government: $1,170

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: 02/06/2008

---