Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits

ICR 201511-0960-013

OMB: 0960-0024

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
0960-0024 201511-0960-013
Historical Active 201506-0960-004
SSA
Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 11/25/2015
Retrieve Notice of Action (NOA) 11/19/2015
  Inventory as of this Action Requested Previously Approved
10/31/2018 10/31/2018 10/31/2018
120,000 0 120,000
20,000 0 20,000
0 0 0

SSA collects information on form SSA-787 to determine an individual’s capability to handle his or her own benefits. This information assists SSA in determining the need for a representative payee. The respondents are beneficiary's physicians or medical officers of the institution in which the beneficiary resides. This is a non-substantive Change Request to include a fillable modality for this ICR.

US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  80 FR 36031 06/23/2015
80 FR 51647 08/25/2015
No

  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 120,000 120,000 0 0 0 0
Annual Time Burden (Hours) 20,000 20,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$184,800
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/19/2015


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