SSA will use this collection to perform an outreach to those medical residents (or their survivors, next of kin, representative payee, etc.) currently entitled to Social Security benefits whose benefits will be affected if they accept a refund of FICA taxes from IRS. This collection is voluntary for respondents, because they are not required to complete the collection to obtain or keep a specific benefit. SSA will call the residents and explain how accepting the refund will affect their Social Security benefits. We will then mail the SSA-795-OP2 to each resident to sign and return to SSA. If SSA cannot reach the resident by phone, we will send a contact letter and the SSA-795-OP2 to the resident to complete and return to SSA. SSA plans to use Form SSA-795-OP2 immediately upon approval and continue to use it for approximately 1 year, during which SSA employees from the Southeastern Program Service Center will only collect this information once per respondent. Once we have the information, we will forward the signed forms to the IRS for the residents who no longer want the FICA refund. The respondents are medical residents who requested a FICA refund from the IRS for their services as a resident during the period of 1993 through 2005.
As per our discussion with OMB, the Social Security Administration (SSA) is requesting emergency clearance for Form SSA-795-OP2, Statement of Claimant or Other PersonÂMedical Resident FICA Refund Claims.
The IRS agreed to postpone issuing the FICA refunds for the residents until we identify those currently entitled to benefits. To document the residents decision to accept or revoke the refund, SSA proposes to send a cover letter and form SSA-795-OP2 to the residents to complete and sign. We expect to use the SSA-795-OP2 immediately upon approval and will continue to use it for approximately 1 year. This is a one-time information collection.
We will use the SSA-795-OP2 to document our contact with medical residents who are currently entitled to benefits and whose benefits we would need to eliminate or reduce if they accept the IRS refund. If the residents decide to take the refund, SSA will remove the earnings from their earnings record (for the period of the refund) and will lower the residents monthly benefit amount. We will fax the signed SSA-795-OP2 to the IRS to notify them of residents who have decided to revoke their request for the refund. SSA will maintain copies of all signed SSA-795-OP2 forms in our Non-Disability Repository for Evidentiary Documents.
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.
Form SSA-795-OP2 Statement of Claimant or Other Person-Medical Resident FICA Refund Claims
OMB No. 0960-NEW (Medical IRS Resident Issue) - emergency request letter.docx
Statement of Claimant or Other Person-Medical Resident FICA Refund Claims