Request for Waiver of Overpayment Recovery or Change in Repayment Rate

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-632-BK Request for Waiver of Overpayment Recovery	Form	Modified	Available
Form SSA-632-BK Request for Change in Repayment Notice	Form	Modified	Available
Supporting Statement 0960 0037 final.doc	Supporting Statement A	Uploaded 2014-05-30	Available
Addendum 0960-0037.doc	Supplementary Document	Uploaded 2014-05-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8941	Request for Waiver of Overpayment Recovery	Form	Modified
195878	Internet Instructions	Instruction	Modified
195877	Regional Application (NY Debt Management-NYDM)	Other-MSSICS Screen	Modified
180027	Request for Change in Repayment Notice	Form	Modified

ICR Details

OMB Control No: 0960-0037	ICR Reference No: 201403-0960-007
Status: Historical Active	Previous ICR Reference No: 201011-0960-011
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Waiver of Overpayment Recovery or Change in Repayment Rate
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: 07/03/2014
	Date Received in OIRA: 06/02/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved	08/31/2014
Responses	1,044,000	0	1,044,000
Time Burden (Hours)	1,004,667	0	1,004,667
Cost Burden (Dollars)	0	0	0

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Abstract: When Social Security beneficiaries and Supplemental Security Income (SSI) recipients receive an overpayment, they must repay the amount of the overpayment. These beneficiaries and recipients can use Form SSA-632-BK to take one of three actions: (1) Request an exemption from repaying, as recovery of the payment would cause financial hardship; (2) inform SSA they want to repay the overpayment at a monthly rate over a period longer than 36 months; and (3) request a different rate of recovery. In the latter two cases, the respondents must also provide financial information to help the agency determine how much the overpaid person can afford to repay each month. Respondents are overpaid beneficiaries or SSI recipients who are requesting a waiver of recovery of an overpayment or a lesser rate of withholding.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 1395pp Name of Law: Social Security Act
   US Code: 42 USC 404 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:
	79 FR 15782	03/21/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 30922	05/29/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Request for Waiver of Overpayment Recovery	SSA-632-BK	Request to Waiver of Overpayment Recovery
Request for Change in Repayment Notice	SSA-632-BK	Request for Waiver of Overpayment Recovery or Change in Repayment Notice
Regional Application (NY Debt Management-NYDM)	SSA-632-BK	Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate
Internet Instructions

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ICR Summary of Burden

table that charts list 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	1,044,000	1,044,000	0	0	0	0
Annual Time Burden (Hours)	1,004,667	1,004,667	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: $3,639,472

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: 06/02/2014

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