Centenarian Project Development Worksheets: Face-to-Face Interview; Telephone Interview

Forms and Documents

Document Name	Status
Addendum - 0780.doc Supplementary Document	2013-03-21
Supporting Statement - 0780.doc Supporting Statement A	2013-03-21

IC Document Collections

IC ID	Document Title	Status
191770	Centenarian Project Development Worksheets: Face-to-Face Interview and Telephone Interview Other-Interview Worksheet	Modified

ICR Details

OMB Control No: 0960-0780	ICR Reference No: 201212-0960-004
Status: Historical Active	Previous ICR Reference No: 201001-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Centenarian Project Development Worksheets: Face-to-Face Interview; Telephone Interview
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: 06/05/2013
	Date Received in OIRA: 03/22/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	36 Months From Approved	06/30/2013
Responses	22,000	0	14,000
Time Burden (Hours)	5,500	0	3,500
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA conducts interviews with centenary title II beneficiaries and title XVI recipients age 100 and older to: (1) assess if the beneficiaries are still living; (2) to prevent fraud, through either identity misrepresentation or representative payee misuse of funds; and (3) to evaluate the well being of the beneficiaries. SSA field office personnel obtain the information through one-time interviews with the centenarians. If the centenarians have representatives or caregivers, SSA personnel invite them to the interviews. During the interview, SSA employees make overall observations of the centenarian and their representative payee (if applicable). The interviewer uses the appropriate Centenarian Development Worksheet as a guide for the interview, in addition to documenting findings during the interview. Non-completion of the Worksheets, or refusal of the interview, does not result in the suspension of the centenarian's payments. SSA conducts the interview either over the telephone or through a face-to-face discussion with the centenarian. This is a national project for our title II beneficiaries and title XVI recipients. Respondents are SSI recipients or Social Security beneficiaries 100 years old or older, their representative payees, or their caregivers.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: The Social Security Act
   US Code: 42 USC 1383 Name of Law: The Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 76591	12/28/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 17276	03/20/2013
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Centenarian Project Development Worksheets: Face-to-Face Interview and Telephone Interview

---

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	22,000	14,000	0	8,000	0	0
Annual Time Burden (Hours)	5,500	3,500	0	2,000	0	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: We increased the public reporting burden as we lowered the age criterion for this program to 100 years or older. This programmatic change increases the respondent pool.

---

Annual Cost to Federal Government: $185,573

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

---

Common Form ICR:  No

---

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: 03/22/2013

---