An individual applying to be a
representative payee for a Social Security, Supplemental Security
Income, or Special Veteran's benefit recipient completes Form
SSA11BK. SSA designed the form to aid our investigation of a
payee applicant. These investigations obtain information from
applicant payees regarding their relationship to the beneficiary,
personal qualifications, their concern for the beneficiary's
well-being, and their intended use of benefits if appointed as
payee. The respondents are individuals, private sector businesses
and institutions, and state and local government institutions and
agencies.
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:
(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;
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.