Privacy and Disclosure of Official Records and Information; Availability of Information and Records to the Public

Forms and Documents

Document Name	Status
Form SSA-3288 d. Consent of Release of Records - 20 CFR 401.100(a)&(b) - SSA-3288 Form and Instruction	Modified
Supporting Statement - 0566 (revised).doc Supporting Statement A	2012-12-04
Revised SSA-3288 Addendum 0912.doc Supplementary Document	2012-09-27

IC Document Collections

IC ID	Document Title	Status
45123	f. Waiver/Reduction of Fees - 20 CFR 402.185	Unchanged
45122	e. FOIA Requests for Records - 20 CFR 402.130	Unchanged
45121	d. Consent of Release of Records - 20 CFR 401.100(a)&(b) - SSA-3288 Form and Instruction	Modified
45120	c. Amendment of Records - 20 CFR 401.65(a)	Unchanged
45119	b. Designating a Representative For Disclosure - 401.55(b)	Unchanged
38034	a. Access to Records - 20 CFR 401.40(b)&(c) & 401.45	Unchanged

ICR Details

OMB Control No: 0960-0566	ICR Reference No: 201209-0960-006
Status: Historical Active	Previous ICR Reference No: 201006-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Privacy and Disclosure of Official Records and Information; Availability of Information and Records to the Public
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: 03/14/2013
	Date Received in OIRA: 12/04/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved	04/30/2013
Responses	3,028,500	0	3,028,500
Time Burden (Hours)	159,133	0	159,133
Cost Burden (Dollars)	0	0	0

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Abstract: Under the Privacy and Disclosure of Official Records and Information, SSA has established methods in which the public can request the following: access to their SSA records; disclosure of SSA records; corrections/amendments to their SSA records; consent for release of records; records accessible through the Freedom of Information Act (FOIA); and waiver/reduction of fees normally charged for release of FOIA records. SSA most often collected the required information for these requests through a written letter, with the exception of the consent for release of records for which there is the Form SSA-3288. Respondents are individuals requesting access to, correction of, or disclosure of SSA records. In this change request, we are making minor wording changes to some of the questions.

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Authorizing Statute(s): US Code: 5 USC 552a Name of Law: The Privacy Act of 1974
   US Code: 5 USC 552 Name of Law: The Freedom of Information 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:
	77 FR 58903	09/24/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 71204	11/29/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
d. Consent of Release of Records - 20 CFR 401.100(a)&(b) - SSA-3288	SSA-3288	Consent for Release of Information
a. Access to Records - 20 CFR 401.40(b)&(c) & 401.45
c. Amendment of Records - 20 CFR 401.65(a)
f. Waiver/Reduction of Fees - 20 CFR 402.185
e. FOIA Requests for Records - 20 CFR 402.130
b. Designating a Representative For Disclosure - 401.55(b)

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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	3,028,500	3,028,500	0	0	0	0
Annual Time Burden (Hours)	159,133	159,133	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: $1,120,000

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: 12/04/2012

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