Supporting Statement for Form SSA-11-BK
Request to be Selected as a Payee
20 CFR 404.2001-404.2065, 20 CFR 416.601-416.665
OMB No. 0960-0014
A. Justification
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 (OASDI), and Supplemental Security Income (SSI) claim may be certified to a relative or some other person (including an appropriate public or private agency) who is concerned with the welfare of the individual. These sections also require the Social Security Administration (SSA) to investigate before certifying payment to the 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 submit such evidence as SSA may need to establish a relationship to, or responsibility for the care of, the beneficiary. The applicant must also submit information that will help SSA determine if their selection as representative payee is in the recipient’s best interest.
SSA currently collects this information via either a traditional paper Form
SSA-11-BK or, more commonly, an electronic version of the form in the Representative Payee System (eRPS), which field office technicians complete during a face-to-face interview with an applicant. Upon OMB approval, SSA will begin using revised paper and electronic versions of the SSA-11-BK as part of an effort to implement the Strengthening Protections for Social Security Beneficiaries Act of 2018 (Public Law No. 115-165), which requires SSA to redetermine the payee appointment whenever a child enters or exits foster care or changes foster care placement.
Description of Collection
SSA requires individuals applying to be representative payees for OASDI, or SSI recipients to complete Form SSA-11-BK or, supply the same information to a field office technician through a personal interview. SSA obtains information from applicant payees regarding their relationship to the recipient; personal qualifications; concerns for the recipient’s well-being; and intended use of payments if appointed as payee. SSA collects this on paper Form SSA-11-BK, or through eRPS, an electronic version of the form, which field office technicians complete during a face-to-face interview with the applicant. The respondents are individuals; private sector businesses and institutions; and State and local government institutions and agencies applying to become representative payees.
Use of Information Technology to Collect the Information
In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Intranet version of Form SSA-11-BK. Based on our data, we estimate approximately 90% of respondents under this OMB number use the eRPS system to apply to be a payee. The remaining 10% of respondents submit the required information by completing the Intranet SSA-11-BK form.
Why We Cannot Use Duplicate Information
The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to obtain similar data.
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, or its electronic equivalent in the RPS, we might inadvertently select a payee who would 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.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on January 25, 2019, at
84 FR 371, and we received no public comments. The 30-day FRN published on March 27, 2019 at 84 FR 11625. 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.
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
Individuals/Households (90%)
Modality of Collection |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Annual Burden (hours) |
Representative Payee System (RPS) |
1,710,000 |
1 |
12 |
342,000 |
Paper Version |
68,400 |
1 |
12 |
13,680 |
Total |
1,778,400 |
|
|
355,680 |
Private Sector (9%)
Modality of Collection |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Total Annual Burden (hours) |
Representative Payee System (RPS) |
171,000 |
1 |
12 |
34,200 |
Paper Version |
6,840 |
1 |
12 |
1,368 |
Total |
177,840 |
|
|
35,568 |
State/Local/Tribal Government (1%)
Modality of Collection |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Total Annual Burden (hours) |
Representative Payee System (RPS) |
19,000 |
1 |
12 |
3800 |
Paper Version |
340 |
1 |
12 |
68 |
Total |
19,340 |
|
|
3,868 |
Grand Total |
1,975,580 |
|
|
395,116 |
The total burden for this ICR is 395,116 hours. We based these figures on current management information data. 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.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $10,047,799. This estimate accounts for cost 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.
15. Program Changes or Adjustments to the Information Collection Request
When we last cleared this IC in 2016, the burden was 311,666 hours. However, we are currently reporting a burden of 395,116. This change stems from SSA adding two additional questions to identify whether a child is in foster care and whether the applicant to be payee is a State Foster Care Agency due to the Public Law. There is no change to the burden time per response
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
17. Displaying the OMB Approval Expiration Date
For the paper Form SSA-11-BK, we will not publish 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.
For the intranet version of Form SSA-11-BK, SSA is not requesting an exception to the requirement to display the OMB approval expiration date.
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 Type | application/msword |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| Last Modified By | SYSTEM |
| File Modified | 2019-03-27 |
| File Created | 2019-03-27 |