Supporting Statement for Form SSA-9584-BK
State Mental Institution Policy Review
OMB No. 0960-0110
A. Justification
1. Sections 205(j)(3)(A) and 1631(a)(2)(C) of the Social Security Act (the Act) provide that the Commissioner of Social Security shall establish a system of accountability monitoring for institutions in each State. Regulations at 20 CFR 404 Subpart U, Representative Payment (Title II), and 20 CFR 416 Subpart F, Representative Payment (Title XVI) of the Code of Federal Regulations, provide the principles and procedures that the Agency follows in determining whether to make representative payment and in selecting a representative payee. These regulations also explain the responsibilities of the representative payee. Specifically, regulations at 20 CFR 404.2035 and 404.2065 (Title II) and 20 CFR 416.635 and 416.665 (Title XVI) explain the representative payee reporting responsibilities.
2. SSA sends the SSA-9584-BK to State mental institutions that participate in SSA's representative payee onsite review program. As a representative payee, the State mental institution has the responsibility to receive and administer payments to beneficiaries who have been determined by SSA to be incapable of managing benefits. SSA is required by law and the regulations (indicated above) to monitor representative payees' use of benefits. Under the onsite review program, SSA conducts a triennial review of State mental institutions in order to determine whether the institutions' policies and practices conform with SSA's regulations in the use of benefits, and the other duties and responsibilities required of representative payees. The SSA-9584-BK obtains information needed by the SSA review team (comprised of representatives from SSA's regional and field offices), and provides a basis for conducting the actual onsite review. In addition, the information is used in the preparation of the subsequent report of findings and recommendations, which is issued to the institutions. Respondents are state mental institutions which serve as representative payees for Social Security beneficiaries and Supplemental Security Income payees.
3. SSA forwards the form to State mental institutions for their completion and return to SSA prior to the onsite review. SSA employees may send a printed version of the form. An electronic non-fillable PDF version of the form is also available for employees to print and mail. At this time, due to the very small universe of respondents, the agency has not committed resources to the creation of an internet version of the form or a fillable electronic version.
4. The nature of the information being collected and the manner in which it is collected preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.
5. This collection does not have a significant impact on a substantial number of small businesses or other small entities.
6. If this information were not collected, SSA would be unable to determine whether the institutional payee needs guidance or if a change in representative payee is required. SSA would not have vital data needed to carry out the onsite review without the information collected on this form. Therefore, this form could not be used less frequently. There are no technical or legal obstacles that prevent burden reduction.
7. There are no special circumstances that would cause this information collection to be conducted in a manner that is not consistent with 5 CFR 1320.5.
8. The 60-day advance Federal Register Notice was published on November 5, 2007, at 72 FR 62510, and SSA has received no public comments. The second Notice was published on January 17, 2008, at 73 FR 3307. There have been no outside consultations with members of the public.
9. SSA provides no payment or gifts to the respondents.
10. The information requested is protected and held confidential in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.
11. The information collection does not contain any questions of a sensitive nature.
12. Form SSA-9584-BK will be used by approximately 95 State or local government institutions annually. The estimated average response time is 1 hour, for a total of 95 burden hours. The total burden is reflected as burden hours, and no separate cost burden has been calculated.
13. There is no known cost burden to the respondents.
14. The annual cost to the Federal Government is approximately $1,170.40. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
15. There have been no program changes in this form. 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.
16. The results of the information collection will not be published.
17. OMB has granted SSA an exemption from the requirement that the expiration date for OMB approval be printed on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms, (e.g., on an annual basis). This exemption was granted so that otherwise useable editions of forms would not be taken out of circulation because the expiration date had been reached. In addition, government waste has been avoided because stocks of forms will not have to be destroyed and reprinted.
18. SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
Statistical methods are not used for this information collection.
| File Type | application/msword |
| File Title | Supporting Statement for Form SSA-9584, |
| Author | SSA |
| Last Modified By | 177717 |
| File Modified | 2008-02-04 |
| File Created | 2007-11-26 |