Data Exchange Request Form

Forms and Documents

Document Name	Status
Form SSA-157 Data Exchange Request Form - State and Local Governments Form	Modified
Form SSA-157 Data Exchange Request Form - Private Sector Respondents Form	Modified
Justification for the Non-Substantive Changes - 0802.docx Justification for No Material/Nonsubstantive Change	2017-04-14

IC Document Collections

IC ID	Document Title	Status
215703	Data Exchange Request Form - State and Local Governments Form	Modified
215635	Data Exchange Request Form - Private Sector Respondents Form	Modified

ICR Details

OMB Control No: 0960-0802	ICR Reference No: 201704-0960-004
Status: Historical Active	Previous ICR Reference No: 201503-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Data Exchange Request Form
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/07/2017
	Date Received in OIRA: 04/14/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2018	08/31/2018	08/31/2018
Responses	146	0	121
Time Burden (Hours)	73	0	61
Cost Burden (Dollars)	0	0	0

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Abstract: SSA engages in various forms of data exchanges from Social Security number verifications to computer matches for benefit eligibility, depending on the requestor's business needs. Section 1106 of the Social Security Act requires we consider the requestor's legal authority to receive the data, our disclosure policies, systems' feasibility, systems' security, and costs before entering into a data exchange agreement. We will use Form SSA-157, Data Exchange Request Form, for this purpose. Respondents are Federal, State, local, and foreign governments, as well as private organizations seeking to share data electronically with SSA. We are submitting a non-substantive Change Request to include the burden and information from 0960-0701 (for which we are submitting a discontinuation request) to this information collection request.

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Authorizing Statute(s): None

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:
	80 FR 9499	02/23/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 24307	04/30/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Data Exchange Request Form - State and Local Governments	SSA-157	Data Exchange Request Form
Data Exchange Request Form - Private Sector Respondents	SSA-157	Data Exchange Request Form

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ICR Summary 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	146	121	0	25	0	0
Annual Time Burden (Hours)	73	61	0	12	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Since we discontinued 0960-0701, and replaced it with the SSA 157, we are including those researchers who previously used 0960-0701 for their epidemiological research requests under 0960-0802. This increased the annual burden by a minimal amount.

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Annual Cost to Federal Government: $0

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: 04/14/2017

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