Statement of Reclamation Action

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-1712-CN Cover Letter CN - Statement of Reclamation Action	Form and Instruction	Modified	Available
Form SSA-1712 Cover Letter - Statement of Reclamation Action	Form and Instruction	Modified	Available
Form SSA-1713 Statement of Reclamation Action	Form	Modified	Available
Form SSA-1712 CN Cover Letter - Notice of Reclamation (Canada Payment Made in Canada)	Form and Instruction	Modified	Available
Form SSA-1712 Cover Letter -Notice of Reclamation (Canada Payments Made in USD)	Form and Instruction	Modified	Available
Form SSA-1713 Statement of Reclamation Action	Form	Modified	Available
Supporting Statement 0960-0734.doc	Supporting Statement A	Uploaded 2015-05-27	Available
Addendum to Supporting Statement 0960-0734.doc	Supplementary Document	Uploaded 2015-04-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
44359	SSA-1713/Not-For-Profit	Other-Revised Privacy Act Statement	Modified
44359	SSA-1713/Not-For-Profit	Form and Instruction	Modified	Cover Letter CN - Statement of Reclamation Action
44359	SSA-1713/Not-For-Profit	Form and Instruction	Modified	Cover Letter - Statement of Reclamation Action
44359	SSA-1713/Not-For-Profit	Form	Modified	Statement of Reclamation Action
44357	SSA-1713/businesses	Other-Revised Privacy Act Statement	Modified
44357	SSA-1713/businesses	Form and Instruction	Modified	Cover Letter - Notice of Reclamation (Canada Payment Made in Canada)
44357	SSA-1713/businesses	Form and Instruction	Modified	Cover Letter -Notice of Reclamation (Canada Payments Made in USD)
44357	SSA-1713/businesses	Form	Modified	Statement of Reclamation Action

ICR Details

OMB Control No: 0960-0734	ICR Reference No: 201503-0960-003
Status: Historical Active	Previous ICR Reference No: 201204-0960-014
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement of Reclamation Action
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/24/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/28/2015
Terms of Clearance: This collection is approved based on the additional materials provided by the Agency.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2018	36 Months From Approved	09/30/2015
Responses	15	0	15
Time Burden (Hours)	1	0	1
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses Form SSA-1713 to collect information to determine if a Canadian bank is able to return erroneous payments, and to determine how and when it can return payments made after the death of a recipient who elects to have payments sent to Canada. Form SSA-1712 (or SSA-1712 CN) is the cover sheet SSA prepares to request return of a payment erroneously made after the death of the recipient. SSA sends Form SSA-1712 with Form SSA-1713. If the bank is the entity that reported the death via a returned payment, SSA does not request Forms SSA-1712 and SSA-1713. The respondents are Canadian financial institutions who received Social Security payments at recipients' request.

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Authorizing Statute(s): US Code: 31 USC 3720 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:
	80 FR 14432	03/19/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 29789	05/22/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
SSA-1713/Not-For-Profit	SSA-1712-CN, SSA-1712, SSA-1713	Statement of Reclamation Action ,   Cover Letter - Statement of Reclamation Action ,   Cover Letter CN - Statement of Reclamation Action
SSA-1713/businesses	SSA-1713, SSA-1712, SSA-1712 CN	Statement of Reclamation Action ,   Cover Letter -Notice of Reclamation (Canada Payments Made in USD) ,   Cover Letter - Notice of Reclamation (Canada Payment Made in Canada)

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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	15	15	0	0	0	0
Annual Time Burden (Hours)	1	1	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: $23

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: 05/28/2015

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