Letter to Custodian of Birth Records

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-L106 Letter to Custodian of Birth Records	Form	Modified	Available
Form SSA-L106 Letter to Custodian of Birth Records	Form	Modified	Available
Form SSA-L706-F3 Letter to Custodian of Birth Records	Form	Modified	Available
Form SSA-L706-F3 Letter to Custodian of Birth Records	Form and Instruction	Modified	Available
Addendum - 0693.doc	Supplementary Document	Uploaded 2016-08-22	Available
Supporting Statement - 0693.docx	Supporting Statement A	Uploaded 2016-08-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9747	SSA-L106 Letter to Custodian of School Records (Private Sector)	Form	Modified	Letter to Custodian of Birth Records
9747	SSA-L106 Letter to Custodian of School Records (Private Sector)	Other-Revised PA Statement	Modified
182865	L106, Letter to Custodian of School Records (Local/State/Tribal Government)	Form	Modified	Letter to Custodian of Birth Records
182865	L106, Letter to Custodian of School Records (Local/State/Tribal Government)	Other-Revised PA Statement	Modified
182860	SSA-L706 Letter to Custodian of Birth Records (Private Sector)	Form	Modified	Letter to Custodian of Birth Records
182860	SSA-L706 Letter to Custodian of Birth Records (Private Sector)	Other-Revised PA Statement	Modified
182859	SSA-L706 Letter to Custodian of Birth Records (State & Local)	Form and Instruction	Modified	Letter to Custodian of Birth Records
182859	SSA-L706 Letter to Custodian of Birth Records (State & Local)	Other-Revised PA Statement	Modified

ICR Details

OMB Control No: 0960-0693	ICR Reference No: 201605-0960-003
Status: Historical Active	Previous ICR Reference No: 201511-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Letter to Custodian of Birth Records
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/25/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/23/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2019	36 Months From Approved	10/31/2016
Responses	7,200	0	7,200
Time Burden (Hours)	1,200	0	1,200
Cost Burden (Dollars)	0	0	0

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Abstract: SSA prepares Form SSA-L106 (Letter to Custodian of School Records)and SSA-L706 (Letter to Custodian of Birth Records) for individuals who need help in obtaining evidence of their age in connection with Social Security number (SSN) card applications and claims for benefits or Supplemental Security Income (SSI). SSA uses the SSA-L106 to determine the existence of primary evidence of age for SSN applicants. SSA also uses both letters to verify with the issuing entity, when necessary, the authenticity of the record submitted by the SSN applicant or claimant. The respondents are schools, State and local bureaus of vital statistics, and religious entities.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 36373	06/06/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 54175	08/15/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
L106, Letter to Custodian of School Records (Local/State/Tribal Government)	SSA-L106	Letter to Custodian of Birth Records
SSA-L106 Letter to Custodian of School Records (Private Sector)	SSA-L106	Letter to Custodian of Birth Records
SSA-L706 Letter to Custodian of Birth Records (Private Sector)	SSA-L706-F3	Letter to Custodian of Birth Records
SSA-L706 Letter to Custodian of Birth Records (State & Local)	SSA-L706-F3	Letter to Custodian of Birth Records

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ICR Summary of Burden

table that charts list of burden

	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	7,200	7,200	0	0	0	0
Annual Time Burden (Hours)	1,200	1,200	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $22,176

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/23/2016

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