20 CFR 404.211(e)(4)
OMB No. 0960-0474
A. Justification
Introduction/Authoring Laws and Regulations
Section 215(b)(2)(A) of the Social Security Act and 20 CFR 404.211(e)(4) permit the exclusion of years from the computation period during which individuals were living with their own (or the spouse's) child under age 3 and has zero earnings in the benefit computation years. SSA uses the information from Form SSA–4162 to determine if an individual qualifies for this exclusion. This child-care dropout exclusion applies to disability benefit computations.
Description of Collection
If individuals applying for title II disability benefits care for their own or their spouse’s children under age 3 and had no steady earnings during that time period, they may exclude that period of care from the disability computation period.
The computation period consists of the earnings period that SSA uses to compute an applicant’s primary insurance amount. If an individual has years of no earnings within the computation period, it may adversely affect the benefit amount. An individual would want to exclude this period from the computation period, because it will more than likely result in a higher benefit amount. We call this the child-care dropout exclusion. SSA uses the information from Form SSA-4162 to determine if an individual qualifies for this exclusion. Respondents are applicants for title II disability benefits.
During the initial disability claim the claims representative (CR) enters the applicant’s information when filling out the work history or reviewing the earnings estimate. If there is a year without earnings, the CR will ask the applicant if either the wage earner or the spouse has a child under the age of three. If the applicant indicates yes, Modernized Claims System (MCS) generates the drop out year screen.
A paper version of Form SSA-4162 is also available on SSA’s intranet for the CR to print and send to the applicant. The paper version is mailed to the applicant if it is later determined that the applicant has years without earnings. The applicant will complete, sign, and mail to SSA, the CR will scan the form into the applicant’s electronic claims file.
Use of Information Technology to Collect the Information
SSA did not create an electronic version of form SSA-4162 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 2,000 respondents complete the form. This is less than the GPEA cut-off of 50,000.
A paper version of Form SSA-4162 is also available on SSA’s intranet for the CR to print and send to the applicant. After the applicant submits the form, the CR scans the form into the applicant’s electronic claims file.
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 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-4162, we would not be able to determine which years to use in the computation period and which years to exclude from the computation as childcare dropout years. Because we only collect the information once, 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 May 13, 2010, at 75 FR 27036, and we received no public comments. SSA published the 30-day Notice on June 3, 2013, at 75 FR 33142. If we receive comments in response to the 30-day Notice, we will forward them to OMB.
We did not consult with the public on the revision 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
Approximately 2,000 respondents take 5 minutes each to complete form SSA 4162. Accordingly, the burden is 167 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 $3,080. This estimate is a projection of the costs for printing and distributing the collection instrument, for collecting the information.
15. Program Changes or Adjustments to the Information Collection Request
There are no changes to the public reporting burden.
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 |
| Author | Ines M Riley |
| Last Modified By | 889123 |
| File Modified | 2013-06-04 |
| File Created | 2013-04-04 |