Representative Payee Report-Special Veterans Benefits

Forms and Documents

Document	Type	Status	Availability
Form SSA-2001-F6 Representative Payee Report-Special Veterans Benefits	Form	Modified	Repair queued
Addendum - 0621.docx	Supplementary Document	Uploaded 2015-06-22	Repair queued
Supporting Statement - 0621.docx	Supporting Statement A	Uploaded 2015-06-22	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
43708	Representative Payee Report-Special Veterans Benefits	Form	Modified

ICR Details

OMB Control No: 0960-0621	ICR Reference No: 201503-0960-006
Status: Historical Active	Previous ICR Reference No: 201203-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Representative Payee Report-Special Veterans Benefits
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: 08/24/2015
	Date Received in OIRA: 07/08/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2018	36 Months From Approved	08/31/2015
Responses	50	0	100
Time Burden (Hours)	8	0	17
Cost Burden (Dollars)	0	0	0

---

Abstract: Title VIII of the Social Security Act allows for payment of monthly Social Security benefits to qualified World War II veterans residing outside the United States. An SSA-appointed representative payee may receive and manage the monthly payment for the beneficiary's use and benefit. SSA uses the information on Form SSA-2001-F6 to determine whether the representative payee used the certified payments properly, and continues to demonstrate strong concern for the beneficiary's best interests. Representative payees who receive Special Veterans Benefits on behalf of beneficiaries residing outside the United States must complete the SSA-2001-F6 annually. We also require these representative payees to complete the form any time we have reason to believe they could be misusing the benefit payments. The respondents are individuals or organizations serving as representative payees who receive Special Veterans Benefits on behalf of beneficiaries living outside the United States.

---

Authorizing Statute(s): US Code: 42 USC 1007 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 17817	04/02/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 35423	06/19/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Representative Payee Report-Special Veterans Benefits	SSA-2001-F6	Representative Payee Report - Special Veterans Benefits

---

ICR Summary 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	50	100	0	0	-50	0
Annual Time Burden (Hours)	8	17	0	0	-9	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: The burden decrease stems from a decrease in the amount of respondents from 100 to 50. We expect the burden to decrease further in the future, as the beneficiaries for the Special Veterans Benefits are a dying population, and, as they decrease, so does their need for representative payees.

---

Annual Cost to Federal Government: $240

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

---

Common Form ICR:  No

---

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: 07/08/2015

---