Justification for the Non-Substantive Changes to 0960-0923

Justification for Non-Substantive Changes for SSA-4641

Authorization for the Social Security Administration to Obtain Account Records from a Financial Institution and Request for Records

Sections 204(a), 1631(b)(1)(B), and 1631(e)(1)(B) of the Social Security Act

OMB No. 0960-0293

Justification for Non-Substantive Changes to the Collection

Background:

On November 2, 2015, the President signed into law H.R. 1314 (Bipartisan Budget Act of 2015). Section 834 of the Bipartisan Budget Act, “Access to Financial Information (AFI) for Waivers and Adjustments of Recovery,” requires the Commissioner to obtain a claimant’s authorization to obtain financial institution records before waiving overpayment recovery under the “defeats the purpose” provision. We use the current version of the SSA-4641 to obtain AFI with regard to Title XVI eligibility. Under the Bipartisan Budget Act, we wish to expand the use of Form SASA-4641 to include obtaining AFI for both Title II and Title XVI waiver determinations. As per the implementation stipulation within the Bipartisan Budget Act, we will implement this revision on February 2, 2016, upon OMB’s approval.

Revisions to the Collection Instrument, SSA-4641 Paper Form:

• Change #1: We added the term “Beneficiary” to the fourth block.

Justification #1: We are expanding the use of this form to include Title II beneficiaries.

• Change #2: We divided the second section of the form into three parts and added checkboxes.

Justification #2: We want to make a clear distinction between the purpose and scope of the form for Title XVI Supplemental Security Income Eligibility; and Title II and Title XVI waiver determinations.

• Change #3: In the “Request for Records” section, we added 204(b), 1631(b)(1)(B) for Title II. We also made a change beginning with the second sentence to add the following:

“..us either to: (1) determine the eligibility of the applicant or recipient named above for Supplemental Security Income (SSI) benefits; or (2) determine if a request to waive a Social Security overpayment defeats the purpose of the Social Security Act.”

Justification #3: We are expanding the use of this form to include obtaining authorization for waiver determinations for both Title II and Title XVI overpayments.

• Change #4: We updated the Privacy Act Statement.

Justification #4: We are expanding the use of this form to include Title II beneficiaries and the current version of this form requires an update to the Privacy Act Statement, per OGC guidance.

Please Note: While our mock-up revised version does not show it, our implemented version of the SSA-4641 will be fillable and printable (just as the current version of this form is fillable and printable).

As mentioned above, we will implement these revisions on February 2, 2016, as per the stipulation within the Bipartisan Budget Act.