Supporting Statement for Form SSA-5-BK
Application for Mother’s or Father’s Insurance Benefits
OMB No. 0960-0003
Justification
Introduction/Authoring Laws and Regulations
Section 202(g) of the Social Security Act (Act) provides for the payment of monthly benefits to the widow or widower of an insured individual if the surviving spouse is caring for a child of the deceased worker who is entitled to Social Security benefits. The regulatory requirements for implementing section 202(g) of the Act are set forth in 20 CFR 404.339 - 404.342 and 20 CFR 404.601 - 404.603 of the Code of Federal Regulations. Sections 202, 205, 223, 226, and 806 of the Act, as amended, allow us to collect this information.
Description of Collection
The Social Security Administration (SSA) uses the information on Form SSA-5-BK to determine an individual’s eligibility for mother’s or father’s insurance benefits. While supplying this information to SSA is voluntary for the applicant, it is required to obtain or retain benefits. The respondents are individuals caring for a child of the deceased worker who is applying for mother’s or father’s insurance benefits under the Old Age, Survivors, and Disability Insurance (OASDI) program.
Use of Information Technology to Collect the Information
SSA created a printable PDF version of Form SSA-5-BK, which is available on our website. SSA also collects the information on the paper Form SSA-5-BK electronically using SSA’s Modernized Claims System (MCS). In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an electronic version of form SSA-5-BK through MCS. Based on our data, we estimate approximately 97% of respondents under this OMB number use the electronic version.
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.
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 use Form SSA-5-BK, eligible individuals would have no way to apply for mother’s or father’s insurance benefits. Because we collect this information on an as needed basis, 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.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on November 9, 2017, at 82 FR 52088, and we received no public comments. The 30-day FRN published on February 1, 2018 at 83 FR 4722. If we receive any comments in response to this Notice, we will forward them to OMB.
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
We estimate approximately 26,032 respondents use either the paper or MCS versions of this application. The following chart shows the burden information for these modalities:
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Total Annual Burden (hours) |
SSA-5-BK (paper version) |
2,697 |
1 |
15 |
674 |
SSA-5-BK (MCS version) |
23,335 |
1 |
15 |
5,834 |
Total |
26,032 |
|
|
6,508 |
The total burden for this ICR is 6,508 hours. We based this figure on current management information data, and it represents burden hours. We did not calculate a separate cost burden.
Annual Cost to the Respondents (Other)
There is no known cost burden to the respondents.
Annual Cost to Federal Government
The annual cost to the Federal government for the form is approximately $27,382. This estimate accounts for costs from the following areas: (1) designing, printing, and distributing the form; (2) SSA employee (e.g., field office, 800 number, DDS staff) information collection and processing time; and (3) systems development, updating, and maintenance costs.
Program Changes or Adjustments to the Information Collection Request
The decrease in burden from 12,991 to 6,508 hours stems from a decreased number of respondents for all collection methods. The figure reported in 2014 was an estimate based on old data. In this ICR, we were able to obtain more accurate management information data for the number of respondents for both MCS and paper versions, and we adjusted our figures accordingly. Finally, we removed the additional MCS IC from this ICR, which we inadvertently did not remove previously once we instituted Signature Proxy for all MCS users. Because we are removing the old MCS IC now, this ICR shows a program change of -6,511 hours. However, as we made this change in 2014 prior to receiving OMB approval in 2015, we have no actual program change at this time (other than for the removal of the IC we inadvertently did not remove for the previous submission of this ICR). We realize we should have removed the IC as soon as possible after OMB approved the previous submission, which is why we are remedying this oversight now. The revisions we are making to the SSA-5-BK are informative only, and they will not change the overall burden for this ICR (see Addendum for more information). We will make the same informative changes to the MCS screens upon OMB’s approval of this ICR.
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 |
| File Title | Supporting Statement for Form SSA-3 |
| Author | Cynthia Mages |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |