Information about Joint Checking/Savings Account

Forms and Documents

Document	Type	Status	Availability
Form SSA-2574 Information About Joint Checking/Savings Account - Paper Version	Form	Modified	Available
Supporting Statement - 0461 (Revised).docx	Supporting Statement A	Uploaded 2019-09-03	Repair queued
Addendum - 0461.docx	Supplementary Document	Uploaded 2019-05-22	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
9346	Information About Joint Checking/Savings Account - Paper Version	Form	Modified
180315	Information About Joint Checking/Savings Account - Intanet Version (SSI Claim System)	Other-SSI Claim System Screens	Modified

ICR Details

OMB Control No: 0960-0461	ICR Reference No: 201902-0960-004
Status: Active	Previous ICR Reference No: 201602-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Information about Joint Checking/Savings Account
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/04/2019
	Date Received in OIRA: 05/24/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2022	36 Months From Approved	09/30/2019
Responses	200,000	0	200,000
Time Burden (Hours)	23,333	0	23,333
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA uses Form SSA-2574 to collect information about checking or savings accounts from both the SSI applicants and recipients, and any other account holder(s) listed on the account. After receiving the completed form, SSA can determine if we should consider the account as a resource for the SSI applicant or recipient. We use Form SSA-2574 to obtain the information via personal interview, or by mail, from the SSI applicant or recipient and from the joint owner of the account. The respondents may complete the form by themselves or with help from SSA employees. Respondents are SSI applicants and recipients, and individuals who list themselves as joint owners of financial accounts with SSI applicants and recipients.

---

Authorizing Statute(s): US Code: 42 USC 1382 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 4597	02/15/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 23623	05/22/2019
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Information About Joint Checking/Savings Account - Intanet Version (SSI Claim System)
Information About Joint Checking/Savings Account - Paper Version	SSA-2574	Information About Joint Checking/Savings Accounts

---

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	200,000	200,000	0	0	0	0
Annual Time Burden (Hours)	23,333	23,333	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:

---

Annual Cost to Federal Government: $848,050

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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

---

Common Form ICR:  No

---

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: 05/24/2019

---