Request for Proof(s) from Custodian of Records

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-L707 SSA-L707 -- Private Sector	Form	Modified	Available
Form SSA-L707 SSA-L707 -- State/Local Government	Form	Modified	Available
Supporting Statement - 0766.docx	Supporting Statement A	Uploaded 2020-04-14	Available
Addendum - 0766.docx	Supplementary Document	Uploaded 2020-01-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181649	SSA-L707 -- Private Sector	Form	Modified
181648	SSA-L707 -- State/Local Government	Form	Modified

ICR Details

OMB Control No: 0960-0766	ICR Reference No: 201908-0960-007
Status: Active	Previous ICR Reference No: 201607-0960-016
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Proof(s) from Custodian of 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: 04/14/2020
	Date Received in OIRA: 01/13/2020
Terms of Clearance: Current agency guidance restricts personnel from sending this form to respondents electronically. One year prior to resubmission, the agency will brief OMB on potential opportunities to changes in GN 00301.195 or other parts of SSA guidance/regulations that would facilitate electronic correspondence when appropriate.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	04/30/2020
Responses	118	0	600
Time Burden (Hours)	20	0	101
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA sends records custodians the SSA-L707 on behalf of individuals who need help obtaining evidence of death, marriage, or divorce in connection with claims for benefits. SSA uses the information from the SSA-L707 to determine eligibility for benefits. The respondents are records custodians including statistics and religious entities, coroners, funeral directors, attending physicians, and State agencies.

---

Authorizing Statute(s): US Code: 42 USC 405 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 53551	10/07/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 70610	12/23/2019
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
SSA-L707 -- Private Sector	SSA-L707	Request for Proof(s) from Custodian of Records
SSA-L707 -- State/Local Government	SSA-L707	Request for Proof(s) from Custodian of Records

---

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	118	600	0	0	-482	0
Annual Time Burden (Hours)	20	101	0	0	-81	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: When we last cleared this IC in 2016, the burden was 101 hours. However, we are currently reporting a burden of 20 hours. This change stems from a decrease in the number of responses from 600 to 118. This change also stems from a decrease in the number respondents who need help obtaining evidence of death, marriage, or divorce in connection with claims for benefits. Although the number of responses changed, SSA did not take any actions to cause this change.

---

Annual Cost to Federal Government: $413

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: 01/13/2020

---