Supporting Statement - 0014

Supporting Statement for Form 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

1. Justification

1. Introduction/Authoring Laws and Regulations

Sections 205(j) and 1631(a)(2) of the Social Security Act (Act) provide that payment of an individual's Old-Age, Survivors and Disability Insurance benefits and Supplemental Security Income (SSI) payments may be certified to a relative or some other person (including an appropriate public or private agency) who is concerned with the welfare of such individual. These sections also require the Social Security Administration (SSA) to investigate before certifying payment to such a third party. Sections 20 CFR 404.2001-404.2065 and 416.601-416.665 of the Code of Federal Regulations set out procedures and policies for implementing the above sections of the statute. These sections require that the representative payee applicant shall submit such evidence as may be needed to establish a relationship to, or responsibility for the care of, the beneficiary or recipient.

2. Description of Collection

SSA requires an individual applying to be a representative payee for a Social Security beneficiary or SSI recipient to complete Form SSA‑11-BK. SSA obtains information from applicant payees regarding their relationship to the beneficiary; personal qualifications; concerns for the beneficiary’s well-being; and intended use of benefits if appointed as payee. SSA collects this information by a traditional paper Form SSA-11-BK or, an electronic version of the form in the Representative Payee System (RPS), which field office technicians complete during a face-to-face interview with an applicant. The respondents are individuals, private sector businesses and institutions, and State and local government institutions and agencies applying to become representative payees.

3. Use of Information Technology to Collect the Information

In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Internet version of Form SSA-11-BK. Based on our data, we estimate approximately 90% of respondents under this OMB number use the electronic version.

4. Why We Cannot Use Duplicate Information

The nature of the information we collect and the manner in which we collect it precludes duplication. SSA does not use another collection instrument to obtain similar data.

5. Minimizing Burden on Small Respondents

This collection does not significantly affect small businesses or other small entities.

6. Consequence of Not Collecting Information or Collecting it Less Frequently

If we did not use Form SSA-11-BK, we may inadvertently select a payee who might not manage the funds in the best interest of the recipient, thereby not meeting the recipient’s needs. Because we collect the information on an as-needed basis, we cannot collect it less frequently. There are no technical or legal obstacles to burden reduction.

7. 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.

8. 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. The 30-day FRN published on April 25, 2016 at 81 FR 24155. If we receive any comments in response to this Notice, we will forward them to OMB. We did not consult with the public in the maintenance of this form.

9. Payment or Gifts to Respondents

SSA does not provide payments or gifts to the respondents.

10. 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.

11. Justification for Sensitive Questions

The information collection does not contain any questions of a sensitive nature.

12. Estimates of Public Reporting Burden

Individuals/Households (90%)

Modality of Completion	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Estimated Annual Burden (hours)
Representative Payee System (RPS)	1,438,200	1	11	263,670
Paper Version	91,800	1	11	16,830
Total	1,530,000			280,500

Private Sector (9%)

Modality of Completion	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Estimated Annual Burden (hours)
Representative Payee System (RPS)	149,940	1	11	27,489
Paper Version	3,060	1	11	561
Total	153,000			28,050

State/Local/Tribal Government (1%)

Modality of Completion	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Estimated Annual Burden (hours)
Representative Payee System (RPS)	16,660	1	11	3054
Paper Version	340	1	11	62
Total	17,000			3,116

Grand Total

1,700,000

311,666

The total burden for this ICR is 311,666 hours. This figure represents burden hours, and we did not calculate a separate cost burden.

13. Annual Cost to the Respondents (Other)

This collection does not impose a known cost burden on the respondents.

14. Annual Cost To Federal Government

The annual cost to the Federal Government is approximately $8,135,745. This estimate is a projection of the costs for printing and distributing the collection instrument, and for collecting the information.

15. Program Changes or Adjustments to the Information Collection Request

There no changes to the public reporting burden.

16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

17. 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.

18. 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).

2. Collections of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.