Notice Regarding Substitution of Party Upon Death of Claimant

Forms and Documents

Document Name	Status
Form HA-539 Notice Regarding Substitution of Party Upon Death of Claimant Form	Modified
Addendum - 0288.doc Supplementary Document	2009-10-16
Supporting Statement - 0288.doc Supporting Statement A	2009-12-10

IC Document Collections

IC ID	Document Title	Status
9191	Notice Regarding Substitution of Party Upon Death of Claimant Form	Modified

ICR Details

OMB Control No: 0960-0288	ICR Reference No: 200908-0960-013
Status: Historical Active	Previous ICR Reference No: 200701-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Notice Regarding Substitution of Party Upon Death of Claimant
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: 03/11/2010
	Date Received in OIRA: 12/10/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2013	36 Months From Approved	04/30/2010
Responses	4,000	0	4,320
Time Burden (Hours)	333	0	360
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA collects information on Form HA-539, when a claimant for Social Security or Supplemental Security Income benefits dies while his or her request for a hearing is pending. The information collected establishes a written record of the request of any individual who asks to be made a substitute party for a deceased claimant, and it facilitates a decision by SSA on whom, if anyone should become a substitute party for the deceased. The ALJ and the hearing office support staff use this information to: (1) establish the relationship of the requester to the deceased claimant; (2) determine the substituted individual's wishes regarding an oral hearing or decision on the record; and (3) admit the data into the claimant's official record as an exhibit. The respondents are individuals requesting to be made a substitute party for a deceased claimant.

---

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:
	74 FR 48795	09/24/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 64801	12/08/2009
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
Notice Regarding Substitution of Party Upon Death of Claimant	HA-539	Notice Regarding Substitution of Party Upon Death of Claimant

---

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	4,000	4,320	0	0	-320	0
Annual Time Burden (Hours)	333	360	0	0	-27	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: The decrease in the public reporting burden was a result of recalculating the incidence of requests from individuals who ask to be made a substitute party for a deceased claimant, based on current 2008 fiscal year statistical data.

---

Annual Cost to Federal Government: $254

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

---

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: 12/10/2009

---