Non-Attorney Representative Demonstration Project Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Annual Affirmations Worksheet	Form and Instruction	Removed	Available
Supporting Statement 0699.doc	Supporting Statement A	Uploaded 2009-12-29	Available
Addendum.doc	Supporting Statement B	Uploaded 2009-10-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9753	Non-Attorney Representative Demonstration Project --Application	Other-Online Collection Screens	Modified
46661	Demonstration Project Annual Affirmations Worksheet	Other-Affirmation Collection Web Screens	Removed
46661	Demonstration Project Annual Affirmations Worksheet	Form and Instruction	Removed	Annual Affirmations Worksheet
46659	Continuing Education	Other-On Line Screens	Modified
191052	Non-Attorney Representative Demonstration Project Application	Other-application	New

ICR Details

OMB Control No: 0960-0699	ICR Reference No: 200909-0960-006
Status: Historical Active	Previous ICR Reference No: 200612-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Non-Attorney Representative Demonstration Project Application
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: 04/20/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/29/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2013	36 Months From Approved	04/30/2010
Responses	700	0	1,250
Time Burden (Hours)	450	0	725
Cost Burden (Dollars)	0	0	0

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Abstract: Section 303 of the Social Security Protection Act of 2004 (SSPA) provides for a 5-year demonstration project to be conducted by SSA under which the direct payment of SSA approved fees is extended to certain non-attorney claimant representatives. To be eligible for direct payment of fees, a non-attorney representative must fulfill 5 key statutory requirements. Through a private contractor SSA will collect required information to determine eligibility for direct payment of representation services.

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Authorizing Statute(s): PL: Pub.L. 108 - 203 205 and 303 Name of Law: Social Security Protection Act of 2004
  

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:
	74 FR 48795	09/24/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 67945	12/21/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Continuing Education
Demonstration Project Annual Affirmations Worksheet	N/A	Annual Affirmations Worksheet
Non-Attorney Representative Demonstration Project --Application
Non-Attorney Representative Demonstration Project Application

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ICR Summary of Burden

table that charts list 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	700	1,250	0	-450	-100	0
Annual Time Burden (Hours)	450	725	0	-75	-200	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We are discontinuing the use of the Annual Affirmations Worksheet collection instrument. This is not a requirement of the Social Security Protection Act (Sections 205 and 303)under the Non-Attorney Representative Payee Demonstration Project. This action reduces the public burden and we can determine participant eligibility based on the remaining collection instruments. The change in the agency estimate is due to a decrease in the number of participants in the project.

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Annual Cost to Federal Government: $500,000

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: 12/29/2009

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