Centenarian Project Development Worksheets: Face-to-Face Interview; Telephone Interview; Third Party Contact; Unable to Locate

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Addendum - Centenarian Project.doc	Supplementary Document	Uploaded 2010-02-23	Available
Supporting Statement- Centenarian Project.doc	Supporting Statement A	Uploaded 2010-04-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
191770	Centenarian Project Development Worksheets: Face-to-Face Interview; Telephone Interview; Third Party Contact; Unable to Locate	Other-Interview Worksheet	New

ICR Details

OMB Control No: 0960-0780	ICR Reference No: 201001-0960-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Centenarian Project Development Worksheets: Face-to-Face Interview; Telephone Interview; Third Party Contact; Unable to Locate
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/15/2010
	Date Received in OIRA: 04/15/2010
Terms of Clearance: OMB is approving this collection with the understanding that SSA will report the collection as a PRA violation with their next Information Collection Budget (ICB) submission.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2013	36 Months From Approved
Responses	14,000	0	0
Time Burden (Hours)	3,500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: SSA is conducting interviews with centenary beneficiaries age 103 and older to : (1) determine if the beneficiaries are still living; (2) prevent fraud, through either identity misrepresentation or representative payee misuse of funds; and (3) assess the well-being of the beneficiaries. SSA’s San Francisco field offices are currently using this survey and we intend to expand its use to all other SSA field offices. Field office personnel obtain the information through onetime, in-person interviews with centenarians. During the interview, SSA employees will make overall observations of the centenarian and their representative payee (if applicable). The interviewer will use the appropriate Centenarian Development Worksheet as a guide for the interview and to document findings. SSA will conduct the interview one time only at the beneficiary’s residence or over the phone if a site visit is not possible. Refusal of the interview will not result in the suspension of the centenarian’s payments. Respondents are Supplemental Security Income recipients or Social Security beneficiaries 103 years old or older, their representative payees, or caregivers.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: The Social Security Act
   US Code: 42 USC 1383 Name of Law: The Social Security Act
  

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:
	75 FR 4606	01/28/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 15761	03/30/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Centenarian Project Development Worksheets: Face-to-Face Interview; Telephone Interview; Third Party Contact; Unable to Locate

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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	14,000	0	0	0	0	14,000
Annual Time Burden (Hours)	3,500	0	0	0	0	3,500
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: This collection, currently in use without OMB approval, increases the public reporting burden. See #12 of the Supporting Statement, or the ICR Summary of Burden above for the burden figures.

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Annual Cost to Federal Government: $185,573

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]? No

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: 04/15/2010

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