Representative Payment Policies Regulation

Forms and Documents

Document Name	Status
0960-0679_supporting_statement (revised).doc Supporting Statement A	2012-06-26

IC Document Collections

IC ID	Document Title	Status
9733	20 CFR 416.611 (a) (1) and 20 CFR416.11 (a) (1)	Modified
44646	20 CFR 404.2025 and 20 CFR 416.625	Modified

ICR Details

OMB Control No: 0960-0679	ICR Reference No: 201204-0960-003
Status: Historical Inactive	Previous ICR Reference No: 200905-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Representative Payment Policies Regulation
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 09/25/2012
	Date Received in OIRA: 06/27/2012
Terms of Clearance: At the request of the Agency, this collection is withdrawn from OMB review.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	36 Months From Approved	10/31/2012
Responses	3,250	0	3,250
Time Burden (Hours)	363	0	363
Cost Burden (Dollars)	0	0	0

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Abstract: In cases where SSA determines that it is not in a beneficiary's best interest to receive payments directly as it may cause substantial harm, the beneficiaries may dispute this decision. If they do, they provide SSA with information which SSA will take into consideration when reevaluating the decision. Representative payees must also provide SSA with information regarding their relationship with the beneficiary, responsibility for the beneficiary, and how payments were used for the beneficiary. Respondents are beneficiaries and representative payees.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 902 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 1007 Name of Law: Social Security Act
   PL: Pub.L. 106 - 169 251(a) Name of Law: Foster Care Independence Act of 1999
  

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:
	77 FR 21616	04/10/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 37728	06/22/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
20 CFR 404.2025 and 20 CFR 416.625
20 CFR 416.611 (a) (1) and 20 CFR416.11 (a) (1)

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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: $50,733

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]? No

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: 06/27/2012

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