Internet Request for Replacement of Form SSA-1099/SSA-1042S

Forms and Documents

Document Name	Status
Addendum to Supporting Statement OMB No 0960-0583 (rev 10-10-12).docx Supplementary Document	2013-01-08
Supporting Statement 0583 (revised).doc Supporting Statement A	2012-12-12

IC Document Collections

IC ID	Document Title	Status
9556	Internet Request for Replacement SSA-1099/1042S Other-Internet Screens for Request for Replacement of Forms SSA-	Modified
204529	Other (Program Service Center) (SSA-1099/1042S) Other-Call flow screens	New
204528	Live calls to local FOs (SSA-1099/1042S) Other-Call Flow Screens	New
204527	Live calls to N8NN SSA-1099/1042S Other-Telephone Call flow Screens	New
204526	Automated Telephone Requestors SSA-1099/1042S Other-Automated Telephone Requestor Screens	New

ICR Details

OMB Control No: 0960-0583	ICR Reference No: 201210-0960-007
Status: Historical Active	Previous ICR Reference No: 200907-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Internet Request for Replacement of Form SSA-1099/SSA-1042S
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: 02/19/2013
	Date Received in OIRA: 01/15/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2016	36 Months From Approved	02/28/2013
Responses	1,775,803	0	136,455
Time Burden (Hours)	102,579	0	22,743
Cost Burden (Dollars)	0	0	0

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Abstract: Title II recipients use Forms SSA-1099 and SSA-1042S, Social Security Benefit Statement, to determine if their Social Security benefits are taxable and the amount they need to report to the Internal Revenue Service. In cases where the original forms are unavailable (e.g., lost, stolen, mutilated), an individual may use SSA's Internet request form or automated telephone application to request a replacement SSA-1099 and SSA-1042S. SSA uses the information from the Internet and automated telephone requests to verify the identity of the requestor and to provide replacement copies of the forms. The Internet and automated telephone options educe requests to the National 800 Number Network (N8NN) and visits to local Social Security field offices. The respondents are applicants for, or claimants of, SSI payments.

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Authorizing Statute(s): US Code: 26 USC 6050F Name of Law: Internal Revenue Code
   US Code: 42 USC 405 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:
	77 FR 67438	11/09/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 1296	01/08/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Live calls to N8NN SSA-1099/1042S
Automated Telephone Requestors SSA-1099/1042S
Live calls to local FOs (SSA-1099/1042S)
Other (Program Service Center) (SSA-1099/1042S)
Internet Request for Replacement SSA-1099/1042S

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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	1,775,803	136,455	0	1,630,413	8,935	0
Annual Time Burden (Hours)	102,579	22,743	0	78,347	1,489	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There has been an increase in burden hours. This increase stems from an increase in the number of respondent requesting replacement Forms SSA-1099 and SSA-1042S via the Internet. The increase is also due to the addition of respondents who request Forms SSA-1099 and SSA-1042S via the automated telephone application.

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Annual Cost to Federal Government: $0

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: 01/15/2013

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