Supporting Statement - 0481

Supporting Statement - 0481.docx

Statement of Funds You Provided to Another, Statement of Funds You Received

OMB: 0960-0481

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Supporting Statement for Forms SSA-2854 & SSA-2855

Statement of Funds You Provided to Another and Statement of Funds You Received

20 CFR 416.1103(f)

OMB No. 0960-0481


A. Justification


  1. Introduction/Authoring Laws and Regulations

20 CFR 416.1103(f) of the Code of Federal Regulations states that money an individual borrows or receives as repayment of a loan does not count as income for Supplemental Security Income (SSI). Commercial loans have formal contracts between borrower and lender that establish specific terms of agreement. However, friends and relatives often engage in informal loan activities with SSI recipients. In these cases, the Social Security Administration (SSA) must decide whether the loan meets the criteria for us to consider it bona fide. SSA collects the information on Forms SSA-2854 and SSA-2855 under authority of Section 1613(e) of the Social Security Act to determine if a loan is bona fide.


  1. Description of Collection

SSA uses Forms SSA-2854 (Statement of Funds You provided to Another) and SSA-2855 (Statement of Funds You Received) to verify if a loan is bona fide for SSI recipients. Form SSA-2854 asks the lender for details on the transaction, and Form SSA-2855 asks the borrower the same basic questions independently. Agency personnel then compare the two statements; gather evidence if needed; and make a decision on the validity of the bona fide status of the loan. For SSI purposes, we consider a loan bona fide if it meets these requirements:


  • Must be between a borrower and lender with the understanding that the borrower has an obligation to repay the money, and


  • Must be in effect at the time the cash goes to the borrower; that is, the agreement cannot come after the cash is paid, and


  • Must be enforceable under State law; often there are additional requirements from the State.


SSA collects this information at the time of initial application for SSI benefits, or at any point when an individual alleges being party to an informal loan while receiving SSI. SSA collects information on the informal loan through personal interviews and mail. The agency’s field personnel conduct the interviews and mail the form(s) for completion, as needed. The respondents are SSI recipients and applicants, and individuals who lend money to them.

  1. Use of Information Technology to Collect the Information

Forms SSA-2854 & SSA-2855 are agency-initiated forms with pre-filled information. This information is not available on any electronic database. SSA did not create an electronic version of Form SSA-2854 or SSA-2855 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 20,000 respondents complete each form. This is less than the GPEA cut-off of 50,000.


  1. 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.


  1. Minimizing Burden on Small Respondents

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


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

If we did not collect the information, SSA would not be able to make accurate SSI eligibility determinations as statute requires. Because we use these forms on an as needed basis, we cannot collect this information less frequently. There are no technical or legal obstacles to burden reduction.


  1. 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.


  1. Solicitation of Public Comment and Other Consultations with the Public

The 60-day advance Federal Register Notice published on November 22, 2017, at

82 FR 55707, 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.


  1. Payment or Gifts to Respondents

SSA does not provide payments or gifts to the respondents.


  1. 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.


  1. Justification for Sensitive Questions

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








  1. Estimates of Public Reporting Burden


Modality of Completion

Number of Respondents

Frequency of Response

Average Burden Per Response (minutes)

Estimated Total Annual Burden (hours)

SSA-2854

20,000

1

10

3,333

SSA-2855

20,000

1

10

3,333

Totals

40,000



6,666


The total burden for this ICR is
6,666 hours. We based these figures on current management data information. We did not calculate a separate cost burden.


  1. Annual Cost to the Respondents (Other)

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


  1. Annual Cost To Federal Government

The annual cost to the Federal Government is approximately $184,800. This estimate accounts for costs from the following areas: (1) designing, printing, and distributing the form; and (2) SSA employee (e.g., field office, 800 number, DDS staff) information collection and processing time.


  1. Program Changes or Adjustments to the Information Collection Request

There are no changes in the public reporting burden.


  1. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.


  1. 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.


  1. 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).


B. Collections of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleTitle of Information Collection and Form Number(s)
AuthorNaomi
File Modified0000-00-00
File Created2021-01-21

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