Request for Waiver of Overpayment Recovery or Change in Repayment Rate

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-632-BK SSA-632 - Request for Waiver of Overpayment Recovery	Form	Modified	Available
Form SSA-634 SSA-634 - Request for Change in Repayment Notice	Form	Unchanged	Available
Justification for the Non-Substantive Changes - 0037.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-05-15	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8941	SSA-632 - Request for Waiver of Overpayment Recovery	Form	Modified
232349	Internet Instructions - SSA-634	Instruction	Unchanged
195878	Internet Instructions - SSA-632	Instruction	Unchanged
195877	Regional Application (NY Debt Management-NYDM)	Other-DMS Screens	Unchanged
180027	SSA-634 - Request for Change in Repayment Notice	Form	Unchanged

ICR Details

OMB Control No: 0960-0037	ICR Reference No: 201904-0960-015
Status: Historical Active	Previous ICR Reference No: 201803-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Waiver of Overpayment Recovery or Change in Repayment Rate
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/31/2019
	Date Received in OIRA: 05/16/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2021	11/30/2021	11/30/2021
Responses	1,060,000	0	1,060,000
Time Burden (Hours)	979,166	0	979,166
Cost Burden (Dollars)	0	0	0

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Abstract: When Social Security beneficiaries and Supplemental Security Income (SSI) recipients receive an overpayment, they must request a waiver, or repay the amount of the overpayment. An overpaid individual may use Form SSA-632-BK to request a waiver from repaying the debt. If an individual believes they cannot repay the debt in 36 months, they use Form SSA 634, to inform SSA that they would like to request a different rate of recovery for their overpayment. The respondents must provide financial information to help SSA determine if the agency can wave their overpayment, or to assist SSA in calculating the amount they can afford to repay each month. Respondents are overpaid individuals who are requesting a waiver of recovery of an overpayment, or a lesser rate of withholding. This is a Non-Substantive Change Request to have the new electronic waiver application screens approved for use.

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Authorizing Statute(s): US Code: 42 USC 404 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 1395pp 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:
	83 FR 21328	05/09/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 38441	08/06/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Regional Application (NY Debt Management-NYDM)	SSA-632-BK, SSA-634	Request For Waiver Of Overpayment Recovery ,   Request for Change in Repayment Notice
Internet Instructions - SSA-632
SSA-632 - Request for Waiver of Overpayment Recovery	SSA-632-BK	Request to Waiver of Overpayment Recovery
SSA-634 - Request for Change in Repayment Notice	SSA-634	Request for Change in Repayment Notice
Internet Instructions - SSA-634

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ICR Summary of Burden

table that charts list 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	1,060,000	1,060,000	0	0	0	0
Annual Time Burden (Hours)	979,166	979,166	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: The decrease to the burden stems from the creation of a new form, the SSA-634. We created the SSA-634 to help eliminate unnecessary time, paperwork, and confusion when individuals are only requesting a change in the overpayment repayment rate. The burden change stems from two factors: (1) a decrease in the number of respondents for the Regional Application from 44,000 to 30,000, which creates a burden savings of 28,000 hours; and (2) an increase in the respondents for the Internet Instructions from 500,000 to 530,000, which would increase our burden by 2,500 hours. Even though we have an increase in burden for Internet Instructions, the burden hours saved from the decrease in Regional Applications creates our overall burden reduction. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change.

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Annual Cost to Federal Government: $3,924,997

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: 05/16/2019

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