Letter to Custodian of Birth Records

Forms and Documents

Document Name	Status
Form SSA-L106 SSA-L106 Letter to Custodian of School Records (Private Sector) Form	Modified
Form SSA-L706 SSA-L706 Letter to Custodian of Birth Records (Beneficiary or Claimant Signature) Form and Instruction	New
Form SSA-L106 SSA-L106 Letter to Custodian of School Records (Beneficiary or Claimant Signature) Form and Instruction	New
Form SSA-L106 L106, Letter to Custodian of School Records (Local/State/Tribal Government) Form	Modified
Form SSA-L706 SSA-L706 Letter to Custodian of Birth Records (Private Sector) Form	Modified
Form SSA-L706 SSA-L706 Letter to Custodian of Birth Records (State & Local) Form and Instruction	Modified
Addendum - 0693.docx Supplementary Document	2019-10-04
Supporting Statement - 0693.docx Supporting Statement A	2020-01-27

IC Document Collections

IC ID	Document Title	Status
9747	SSA-L106 Letter to Custodian of School Records (Private Sector) Form	Modified
238009	SSA-L706 Letter to Custodian of Birth Records (Beneficiary or Claimant Signature) Form and Instruction	New
238008	SSA-L106 Letter to Custodian of School Records (Beneficiary or Claimant Signature) Form and Instruction	New
182865	L106, Letter to Custodian of School Records (Local/State/Tribal Government) Form	Modified
182860	SSA-L706 Letter to Custodian of Birth Records (Private Sector) Form	Modified
182859	SSA-L706 Letter to Custodian of Birth Records (State & Local) Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0693	ICR Reference No: 201904-0960-011
Status: Active	Previous ICR Reference No: 201605-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Letter to Custodian of Birth Records
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: 01/28/2020
	Date Received in OIRA: 10/04/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	36 Months From Approved	01/31/2020
Responses	1,774	0	7,200
Time Burden (Hours)	163	0	1,200
Cost Burden (Dollars)	0	0	0

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Abstract: SSA prepares Form SSA-L106 (Letter to Custodian of School Records)and SSA-L706 (Letter to Custodian of Birth Records) for individuals who need help in obtaining evidence of their age in connection with Social Security number (SSN) card applications and claims for benefits or Supplemental Security Income (SSI). SSA uses the SSA-L106 to determine the existence of primary evidence of age for SSN applicants. SSA also uses both letters to verify with the issuing entity, when necessary, the authenticity of the record submitted by the SSN applicant or claimant. The respondents are the beneficiaries and claimants who sign the letters; and the schools, State and local bureaus of vital statistics, and religious entities who submit the information regarding evidence of age for the beneficiary or claimant.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
  

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:
	84 FR 25891	06/04/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 40121	08/13/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
SSA-L106 Letter to Custodian of School Records (Private Sector)	SSA-L106	Letter to Custodian of Birth Records
SSA-L706 Letter to Custodian of Birth Records (Private Sector)	SSA-L706	Letter to Custodian of Birth Records
SSA-L706 Letter to Custodian of Birth Records (State & Local)	SSA-L706	Letter to Custodian of Birth Records
L106, Letter to Custodian of School Records (Local/State/Tribal Government)	SSA-L106	Letter to Custodian of Birth Records
SSA-L706 Letter to Custodian of Birth Records (Beneficiary or Claimant Signature)	SSA-L706	Letter to Custodian of Birth Records
SSA-L106 Letter to Custodian of School Records (Beneficiary or Claimant Signature)	SSA-L106	Letter to Custodian of School Records

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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	1,774	7,200	0	0	-5,426	0
Annual Time Burden (Hours)	163	1,200	0	0	-1,037	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: There is a significant decrease in the public reporting burden. This change stems from a decrease in the number of respondents using these forms. The figures reported in 2016 were an estimate based on old data. In this ICR, we were able to obtain more accurate information data for the number of respondents. There is no change to the burden time per response for the respondents who complete these forms. SSA did not take any actions to cause this change. In addition, we are increasing the burden by including the one-minute burden for the claimants and beneficiaries for whom we complete this form to sign these forms before we send them. While we have always asked the claimants or beneficiaries to sign these forms, we only recently realized that we were no longer showing this minor burden in our burden estimates. This is an oversight, which we are correcting now.

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Annual Cost to Federal Government: $3,106

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

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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: 10/04/2019

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