Supporting Statement for Form SSA-11-BK
Request to be Selected as a Payee
20 CFR 404.2010-404.2055, 20 CFR 416.601-416.665
OMB No. 0960-0014
A. Justification
Introduction/Authoring Laws and Regulations
Sections 205 (j) and 1631 (a) (2) of the Social Security Act (the Act) provide that payment of an individual's Old-Age, Survivors and Disability Insurance and Supplemental Security Income (SSI) benefits may be certified to a relative or some other person (including an appropriate public or private agency) who is concerned with the welfare of such individual. These sections also require the Social Security Administration (SSA) to investigate before certifying payment to such a third party. Sections 20 CFR 404.2010-404.2055 and 416.601-416.665 of the Code of Federal Regulations set out procedures and policies for implementing the above sections of the statute. These sections require that the representative payee applicant shall submit such evidence as may be needed to establish a relationship to, or responsibility for, the care of the beneficiary.
On March 2, 2004, Congress enacted the Social Security Protection Act of 2004 (SSPA), P. L. 108-203, into law. Sections 103 and 203 of P. L. 108-203 made changes to the representative payment program. Section 103 of P. L. 108-203 amends section 205(j)(2) of the Act, specifically describing individuals who SSA should not choose to serve as representative payees. Section 205(j)(2)(A) requires the agency to investigate the representative payee applicant prior to certifying payment of another person’s benefit to them as a representative payee. As part of the investigation, Section 103 of the SSPA amends Section 205(j)(2)(B) of the Act to require that the agency obtain information concerning whether the applicant committed any offense under federal or state law that resulted in conviction and imprisonment for more than 1 year.
Description of Collection
An individual applying to be a representative payee for a Social Security beneficiary or SSI recipient must first complete Form SSA-11-BK. SSA obtains information from applicant payees regarding their relationship to the beneficiary, personal qualifications, concerns for the beneficiary’s well-being, and intended use of benefits if appointed as payee. The respondents are individuals, private sector businesses and institutions, and State and local government institutions and agencies applying to become representative payees.
Use of Information Technology to Collect the Information
In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Internet version of Form SSA-11-BK. Based on our data, we estimate approximately 90% of respondents under this OMB number use the electronic version.
Why We Cannot Use Duplicate Information
The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to obtain similar data.
Minimizing Burden on Small Respondents
This collection does not significantly affect small businesses or other small entities.
6. Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-11-BK, we may inadvertently select a payee who might not manage the funds in the best interest of the beneficiary, thereby not meeting the beneficiary’s needs. Because we collect the information on an as needed basis, we cannot collect it less frequently.
There are no technical or legal obstacles to burden reduction.
7. Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on April 2, 2013, at
78 FR 19794, and we received no public comments. The 30-day FRN published on June 3, 2013 at 78 FR 33142. If we receive any comments in response to this Notice, we will forward them to OMB. We did not consult with the public in the maintenance of this form.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Individuals/Households (90%)
Modality of Collection |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Annual Burden (hours) |
Representative Payee System (RPS) |
1,438,200 |
1 |
11 |
263,670 |
Paper Version |
91,800 |
1 |
11 |
16,830 |
Total |
1,530,000 |
|
|
280,500 |
Private Sector (9%)
Modality of Collection |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Total Annual Burden (hours) |
Representative Payee System (RPS) |
149,940 |
1 |
11 |
27,489 |
Paper Version |
3,060 |
1 |
11 |
561 |
Total |
153,000 |
|
|
28,050 |
State/Local/Tribal Government (1%)
Modality of Collection |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Total Annual Burden (hours) |
Representative Payee System (RPS) |
16,660 |
1 |
11 |
3054 |
Paper Version |
340 |
1 |
11 |
62 |
Total |
17,000 |
|
|
3,116 |
Grand Total |
1,700,000 |
|
|
311,666 |
The total burden for this ICR is 311,666 hours. This figure represents burden hours, and we did not calculate a separate cost burden.
13. Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $8,135,745. This estimate is a projection of the costs for printing and distributing the collection instrument, and for collecting the information.
15. Program Changes or Adjustments to the Information Collection Request
There has been an increase in burden hours. This change stems from an increase in the number of representative payee applications taken.
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
17. Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/msword |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| Last Modified By | 889123 |
| File Modified | 2013-06-04 |
| File Created | 2013-03-05 |