Justification for the Non-Substantive Changes for OMB # 0960-0014

Justification for Non-Substantive Changes for SSA-11-BK

Request to be Selected as a Payee

20 CFR 404.2010-404.2055, 20 CFR 416.601-416.665

OMB No. 0960-0014

Background

An individual applying to be a representative payee for a Social Security beneficiary or SSI recipient must first supply information by either completing the paper Form SSA‑11‑BK or, more commonly, supplying the same information to a field office technician who enters the data into the electronic Representative Payee System (RPS). In this way, SSA gathers information from the payee applicant regarding their relationship to the beneficiary; personal qualifications; concerns for the beneficiary’s well-being; and intent of use of benefits if appointed as payee. The respondents are individuals, private sector businesses and institutions, and State and local government institutions and agencies applying to become representative payees.

Revisions to the Collection Instrument

SSA is making the following revisions to the paper Form SSA-11-BK and the associated RPS screens:

• Change #1: In question 15, we are relabeling “AFDC (County and State)” to read, “Temporary Assistance for Needy Families (TANF).”

Justification #1: We made these corrections to reflect the current name for the needs-based assistance.

• Change #2: In question 15, we are replacing “Other Welfare (describe)” with, “State or Public Assistance (describe).”

Justification #2: This reflects the current name for this kind of needs-based assistance and adds specificity to the question.

• Change #3: We are adding a question (no. 16) which asks for consent to conduct a criminal background check on the payee applicant.

Justification #3: We added the question because we are adopting a new policy to enhance our investigative procedure for payee applicants, specifically to conduct a criminal background check.

We will make these updates as soon as possible after we receive OMB approval.

This action does not affect the public reporting burden.