Request for Waiver of Overpayment Recovery or Change in Repayment Rate

Forms and Documents

Document Name	Status
Form SSA-632-BK Request for Waiver of Overpayment Recovery Form and Instruction	Modified
Form SSA-632-BK Request for Change in Repayment Notice Form and Instruction	Modified
Addendum--0037.doc Supplementary Document	2009-02-26
Supporting Statement--0037.doc Supporting Statement A	2009-02-26

IC Document Collections

IC ID	Document Title	Status
8941	Request for Waiver of Overpayment Recovery Form and Instruction	Modified
180027	Request for Change in Repayment Notice Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0037	ICR Reference No: 200812-0960-008
Status: Historical Active	Previous ICR Reference No: 200705-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Waiver of Overpayment Recovery or Change in Repayment Rate
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: 05/03/2009
	Date Received in OIRA: 02/26/2009
Terms of Clearance: This ICR is approved for 2 years. SSA should review whether this form should be included in their next review of forms for electronic implementation prior to resubmission for OMB approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2011	36 Months From Approved	04/30/2009
Responses	500,000	0	500,000
Time Burden (Hours)	916,666	0	875,000
Cost Burden (Dollars)	0	0	0

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Abstract: The overpaid individual uses the SSA–632–BK to request a waiver of recovery of an overpayment. The individual explains why they feel they are without fault in causing the overpayment and provides financial information, so SSA can determine whether recovery would cause financial hardship. If the individual agrees to repay the overpayment, they can use the SSA–632–BK to inform SSA they want to repay at a monthly rate that would take more than thirty-six months to recover the overpayment. The individual can also use the SSA–632–BK to request a different rate of recovery. In those cases, they must provide financial information to SSA for a determination of how much the overpaid person can afford to repay each month. Respondents are overpaid beneficiaries or claimants who are requesting a waiver of recovery of the overpayment, or a lesser rate of withholding.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: null
   US Code: 42 USC 1395pp Name of Law: null
   US Code: 42 USC 404 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:
	73 FR 75488	12/11/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 7506	02/17/2009
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
Request for Waiver of Overpayment Recovery	SSA-632-BK	Request to Waiver of Overpayment Recovery
Request for Change in Repayment Notice	SSA-632-BK	Request for Waiver of Overpayment Recovery or Change in Repayment Notice

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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	500,000	500,000	0	0	0	0
Annual Time Burden (Hours)	916,666	875,000	0	41,666	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is no change in the burden data for the usage of the Form SSA-632-BK. However, we inadvertently did not include the burden data for the instructions which appear on the Internet for the paper SSA-632-BK. These instructions which are accessible from the www.ssa.gov website, help those respondents who are filling out the form without help from field office representatives. We believe that since all of the respondents for the SSA-632-BK have the potential to review these instructions, we have an increase in burden hours of 5 minutes per respondent or 41,666 total burden hour increase.

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Annual Cost to Federal Government: $3,080,000

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)? No

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: 02/26/2009

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