Representative Payment Policies and Administrative Procedures for Imposing Penalties for False or Misleading Statements or Withholding of Information

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Addendum 0740.doc	Supplementary Document	Uploaded 2015-11-23	Available
Supporting Statement - 0960-0740.docx	Supporting Statement A	Uploaded 2015-11-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45746	20 CFR 404.2035(f) - Intranet/Field office interview	Other-Sample in-office screen shots	Modified
45745	20 CFR 404.2035(d) - Intranet/Field Office Interview	Other-Sample in-office screen shots	Modified
45744	20 CFR 416.635(f) - Paper		Modified
45743	20 CFR 416.635(d) - Paper		Modified
45740	20 CFR 404.2035(f) - Paper		Modified
45739	20 CFR 404.2035(d) - Paper		Modified
191381	20 CFR 416.635(f) - Intranet/Field Office Interview	Other-Sample in-office screen shots	Modified
191380	20 CFR 416.635(d) - Intranet/Field office interview	Other-Sample in-office screen shots	Modified

ICR Details

OMB Control No: 0960-0740	ICR Reference No: 201508-0960-006
Status: Historical Active	Previous ICR Reference No: 201210-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Representative Payment Policies and Administrative Procedures for Imposing Penalties for False or Misleading Statements or Withholding of Information
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: 01/05/2016
	Date Received in OIRA: 11/23/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	36 Months From Approved	02/29/2016
Responses	882,840	0	858,500
Time Burden (Hours)	73,570	0	71,543
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection request comprises several regulation sections that provide additional safeguards for Social Security beneficiaries whose representative payees receive their payments. SSA requires representative payees to notify us of any event or change in circumstances that would affect receipt of benefits or performance of payee duties. SSA uses the information to determine continued eligibility for benefits, the amount of benefits due, and if the payee is suitable to continue serving as payee. The respondents are representative payees who receive and use benefits on behalf of Social Security beneficiaries.

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Authorizing Statute(s): PL: Pub.L. 108 - 123 101-420 Name of Law: Social Security Protection Act
   US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1007 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: PL: Pub.L. 108 - 123 101-420 Name of Law: Social Security Protection Act

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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 53608	09/04/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 71908	11/17/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
20 CFR 416.635(f) - Intranet/Field Office Interview
20 CFR 416.635(d) - Paper
20 CFR 416.635(f) - Paper
20 CFR 404.2035(d) - Intranet/Field Office Interview
20 CFR 404.2035(f) - Intranet/Field office interview
20 CFR 404.2035(f) - Paper
20 CFR 404.2035(d) - Paper
20 CFR 416.635(d) - Intranet/Field office interview

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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	882,840	858,500	0	0	24,340	0
Annual Time Burden (Hours)	73,570	71,543	0	0	2,027	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: There is an increase in burden hours. The increase stems from an increase in the number of representative payees who notify SSA of events or changes in Social Security beneficiaries circumstances.

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Annual Cost to Federal Government: $1,136,000

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: 11/23/2015

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