Form SSA-4162
20 CFR 404.211(e)(4)
OMB No. 0960-0474
Justification
Introduction/Authoring Laws and Regulations
Section 215(b)(2)(A) of the Social Security Act and 20 CFR 404.211(e)(4) of the Code of Federal Regulations permit the exclusion of years from the computation period during which individuals were living with their own (or their spouse's) child under age 3, and has zero earnings in the benefit computation years. We refer to this exclusion as the child-care dropout years, and it applies to disability benefit computations.
Description of Collection
The basic Social Security disability benefits application form (cleared under OMB No. 0960-0618) contains a lead question asking if the applicant cared for their own or their spouse’s children under age 3 and had no earnings during that period. If the answer is yes, the applicant completes Form SSA-4162 (either on paper or through an SSA claims representative (CR) during a personal interview). SSA uses the information to determine if the applicant qualifies for the child-care exclusion. For the modernized claims system (MCS) application version, the beneficiary provides the information verbally to the SSA claims representative (CR) during a personal interview, and the CR inputs the information directly into the MCS application. The CR prints the MCS application for the beneficiary to verify and sign. Respondents are applicants for Title II disability benefits.
Use of Information Technology to Collect the Information
SSA did not create an electronic version of Form SSA-4162 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 2,000 respondents complete the form. This is less than the GPEA cut-off of 50,000. We do, however, make the form available to the public as a printable PDF through SSA’s website.
Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it preclude duplication. SSA does not use another collection instrument to obtain similar data.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not collect the information, we would not be able to determine which years to use in the computation period, and which years to exclude from the computation as childcare dropout years. This would be a violation of regulations at 20 CFR 404.211(e)(4). Because we only collect the information once, we cannot collect it less frequently. There are no technical or legal obstacles to burden reduction.
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.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on February 18, 2016, at 81 FR 8323, and we received no public comments. SSA published the second Notice on April 25, 2016, at 81 FR 24155. If we receive comments in response to the 30‑day Notice, we will forward them to OMB. We did not consult with the public in the revision of this form.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
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.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Approximately 2,000 respondents take 5 minutes each to complete form SSA-4162. Accordingly, the burden is 167 hours. This figure represents burden hours, and we did not calculate a separate cost burden.
Annual Cost to the Respondents
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $3,080. This estimate is a projection of the costs for printing and distributing the collection instrument, for collecting the information.
Program Changes or Adjustments to the Information Collection Request
There are no changes to the public reporting burden.
Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
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.
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).
Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ines M Riley |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |