Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody

Forms and Documents

Document	Type	Status	Availability
Form SSA-781 Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody	Form	Modified	Available
Supporting Statement 0019 (revised).doc	Supporting Statement A	Uploaded 2010-06-23	Available
Addendum to Supporting Statement.doc	Supplementary Document	Uploaded 2010-05-10	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
8911	Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody	Form	Modified

ICR Details

OMB Control No: 0960-0019	ICR Reference No: 201002-0960-011
Status: Historical Active	Previous ICR Reference No: 200710-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody
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: 08/04/2010
	Date Received in OIRA: 06/23/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2013	36 Months From Approved	09/30/2010
Responses	14,000	0	14,000
Time Burden (Hours)	2,333	0	2,333
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses Form SSA-781 to determine if non-custodial parents who are filing for spouse’s or mother’s and father’s benefits based on having a child in their care meet the in-care requirements. If the child leaves the respondent’s care, the respondent completes Form SSA-781 in order for an SSA employee to determine if the respondent meets the “in care” entitlement requirement. The respondents are applicants for spouse's and/or mother’s and father’s benefits.

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Authorizing Statute(s): US Code: 42 USC 402 Name of Law: 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 9992	03/04/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 27036	05/13/2010
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody	SSA-781	Certificate of Responsibility for Welfare Care of a Child Not in Applican'ts Custody

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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	14,000	14,000	0	0	0	0
Annual Time Burden (Hours)	2,333	2,333	0	0	0	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:

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Annual Cost to Federal Government: $54,319

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: 06/23/2010

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