Supporting Statement - 0960-0633

Supporting Statement - 0960-0633.docx

Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form

OMB: 0960-0633

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Supporting Statement for Forms SSA-637 and SSA-639

Site Review Questionnaire for Volume and Fee-for-Service Payees, and

Beneficiary Interview Form

20 CFR 404.2035, 404.2065, 416.665, 416.701, and 416.708

OMB No. 0960-0633



A. Justification


  1. Introduction/Authoring Laws and Regulations

Section 205(j)(1)(A) and section 1631(a)(2) of the Social Security Act (Act) provide for the payment of Social Security benefits and Supplemental Security Income (SSI) to a relative, another person, or an organization when it will serve the best interest of the beneficiary or SSI recipient. Sections 20 CFR 404.2065 and 416.665 of the Code of Federal Regulations require representative payees to keep records on the use of benefits and payments, and to submit a written report accounting for these benefits to SSA. These regulations also specify that SSA may verify, in certain situations, how a representative payee used the funds.

20 CFR 404.2035, 416.701 and 416.708 discuss the responsibilities of representative payees.


In March 2004, Congress passed Public Law (Pub.L.) 108-203. Section 102(b) of Pub.L. 108-203, amended sections 205(j)(6)(A) and 1631(a)(2)(G)(i) of the Act to require SSA to conduct periodic on-site (site) reviews of representative payees who meet the criteria described in sections 205(j)(6)(A)(i), 205(j)(6)(A)(ii), 205(j)(6)(A)(iii), 1631(a)(2)(G)(i)(I), 1631(a)(2)(G)(i)(II), and 1631(a)(2)(G)(i)(III) of the Act. We use Forms SSA-637 and SSA-639 to verify representative payees comply with their responsibilities to keep records on their use of Social Security benefits and SSI payments (20 CFR 404.2065 and 416.665) and make the required reports (20 CFR 404.2035, 416.701 and 416.708). We also use the forms to assist us in fulfilling our responsibility to conduct periodic on‑site (site) reviews of representative payees under sections 205(j)(6)(A) and 1631(a)(2)(G)(i) of the Act.


  1. Description of Collection

SSA asks organizational representative payees to complete Form SSA-637, the Site Review Questionnaire for Volume and Fee-for-Service Payees, to provide information on how they carry out their responsibilities, including how they manage beneficiary funds. SSA then obtains information from the beneficiaries these organizations represent via Form SSA-639, Beneficiary Interview Form, to corroborate the payees’ statements. Due to the sensitivity of the information, SSA employees always complete the forms based on the answers respondents give during the interview. The respondents are individuals; State and local governments; non-profit and for profit organizations serving as representative payees; and the beneficiaries they serve.


  1. Use of Information Technology to Collect the Information

This is a paper information collection available as a PDF print-only form on the SSA Intranet. Only SSA employees complete the forms during the interviews with representative payees, beneficiaries, and SSI recipients during on-site reviews. SSA did not create electronic version of Forms SSA-637 and

SSA-639 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 10,292 respondents complete the form. This is less than the GPEA cut-off of 50,000.


  1. Why We Cannot Use Duplicate Information

Some of the information collection (e.g., questions on direct deposit of benefits) may duplicate information contained in SSA's Representative Payee System (RPS). However, SSA needs to collect current information to ensure our records are accurate and up to date, to ascertain representative payee fraud, and to ensure representative payees are complying with their fiduciary and reporting responsibilities for beneficiaries and SSI recipients. The RPS system may not have the most recent information.


  1. Minimizing Burden on Small Respondents

This collection affects small businesses or other small entities. However, if we did not impose this burden, we would be unable to verify that small business or other small entities serving as representative payees comply with their fiduciary and reporting responsibilities, which they agreed to perform on behalf of beneficiaries and SSI recipients. We minimized the burden by carefully reviewing the form and ensuring we only ask small businesses or entities to complete relevant and necessary questions. In addition, for those representative payees subject to site reviews under sections 205(j)(6)(A) and 1631(a)(2)(G)(i) of the Act, the information collection is quadrennial (i.e., once every 4 years). For other representative payees, the collection is one-time. In this way, we only request the information when necessary.


6. Consequence of Not Collecting Information or Collecting it Less Frequently If we did not collect this information, SSA would be in violation of the law. We need the information to fulfill our responsibility to conduct periodic on-site reviews of representative payees, and, therefore, 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.


  1. Solicitation of Public Comment and Other Consultations with the Public

The 60-day advance Federal Register Notice published on July 23, 2015, at

80 FR 43828, and we received no public comments. The 30-day FRN published on September 25, 2015, at 80 FR 57907. If we receive any comments in response to this Notice, we will forward them to OMB.

  1. Payment or Gifts to Respondents

SSA does not provide payments or gifts to the respondents.


  1. 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.


  1. Justification for Sensitive Questions

The information collection does not contain any questions of a sensitive nature.


  1. Estimates of Public Reporting Burden

Modality of Completion

Number of Responses

Frequency of Response

Average Burden Per Response (minutes)

Estimated Total Annual Burden (hours)

SSA-637

1,999

1

120

3,998

SSA-639

8,293

1

10

1,382

Totals

10,292



5,380












The total burden for this ICR is 5,380 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.


  1. Annual Cost To Federal Government

The annual cost to the Federal Government is approximately $233,069. This estimate is a projection of the costs for field office employees to collect the information.


15. Program Changes or Adjustments to the Information Collection Request

There are no changes to the public burden hours of this information collection.


16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection. However, SSA provides Congress with an annual report on our progress in increasing the oversight of organizational payees and improving the monitoring process, including the number of site reviews SSA conducts, relevant findings, and corrective actions.


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.


  1. 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.









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File TitleTitle of Information Collection and Form Number(s)
AuthorNaomi
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