20 CFR 416.1103(f)
A. Justification
Introduction/Authoring Laws and Regulations
Per 20 CFR 416.1103(f) of the Code of Federal Regulations money an individual borrows or receives as repayment of a loan does not count as income for Supplemental Security Income (SSI). Commercial loans have formal contracts between borrower and lender that establish specific terms of the agreement. However, friends and relatives often engage in informal loan activities with SSI beneficiaries. In those cases, the Social Security Administration (SSA) must decide whether the loan meets the criteria for us to consider it bona fide. SSA collects the information on these forms under authority of Section 1613(e)(1)(B), Title XVI of the Social Security Act (Act).
Description of Collection
SSA uses forms SSA-2854 (Statement of Funds You provided to Another) and SSA -2855 (Statement of Funds You Received) to verify if a loan is bona fide for SSI recipients. Form SSA-2854 asks the lender for details on the transaction, and Form SSA-2855 asks the borrower the same basic questions independently. Agency personnel then compare the two statements, gather evidence if needed, and make a decision on the validity of the bona fide status of the loan. For SSI purposes, we consider a loan bona fide if it meets these requirements:
Must be between a borrower and lender with the understanding that the borrower has an obligation to repay the money, and
Must be in effect at the time the cash goes to the borrower; that is, the agreement cannot come after the cash is paid, and
Must be enforceable under State law; often there are additional requirements from the State.
SSA collects this information at the time of initial application for SSI benefits or at any point when an individual alleges being party to an informal loan while receiving SSI. SSA collects information on the informal loan by interview and mail. The agency’s field personnel conduct the interviews and mail the form(s) for completion, as needed. The respondents are SSI recipients and applicants, and individuals who lend money to them.
Use of Information Technology to Collect the Information
Forms SSA-2854 & SSA-2855 are agency-initiated forms with pre-filled information. This information is not available on an electronic database and only.
SSA did not create an electronic version of Form SSA-2854 or SSA- 2855 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 20,000 respondents complete each form. This is less than the GPEA cut-off of 50,000.
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.
Consequence of Not Collecting Information or Collecting it Less Frequently
SSA needs to collect this information when certain individuals apply for or reaffirm eligibility for SSI payments. If we did not collect the information, SSA would not be able to make accurate eligibility determinations as required by statute. Because we use these forms on an as needed basis, we cannot collect this information less frequently. There are no technical or legal obstacles to prevent burden reduction.
Special Circumstances
There are no special circumstances that would cause SSA to collect this information 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 October 14, 2014, at 79 FR 61366, and we received no public comments. The 30-day FRN published on December 22, 2014 at 79 FR 76435. 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.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden Per Responses (minutes) |
Estimated Total Annual Burden (hours) |
SSA-2854 |
20,000 |
1 |
10 |
3,333 |
SSA-2855 |
20,000 |
1 |
10 |
3,333 |
Totals |
40,000 |
|
|
6,666 |
The total burden for this ICR is 6,666 hours. This figure represents burden hours, and we did not calculate a separate cost burden.
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 $184,800.00. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
Program Changes or Adjustments to the Information Collection Request
There are no changes in the public reporting burden. However, we separated the two forms into two separate ICs.
Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
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/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| File Modified | 0000-00-00 |
| File Created | 2021-01-26 |