SSI Notice of Interim Assistance Reimbursement (IAR)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-L8125-F6 Supplemental Security Income Notice of Interim Assistance Reimbursement	Form and Instruction	Modified	Available
Addendum - 0546 (Final).docx	Supplementary Document	Uploaded 2024-05-15	Available
Addendum - 0546.docx	Supplementary Document	Uploaded 2020-10-06	Repair queued
Supporting Statement - 0546 (Final).docx	Supporting Statement A	Uploaded 2024-05-15	Available
Supporting Statement - 0546.docx	Supporting Statement A	Uploaded 2020-10-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9467	a) State Notification of Receipt of Authorization (Electronic Process)	Other-Internet Screens	Modified
186519	m) Correct Administrative and Accounting Discrepancies		Modified
186518	l) Participate in Periodic Review		Modified
186517	k) Retrieve and Consolidate Authorization and Accounting Forms		Modified
186516	j) Written Notice from State to Recipient Regarding Amount of Payment		Modified
186515	i) Maintenance of Accounting Forms and Notices		Modified
186514	h) Maintenance of Authorization Forms		Modified
186513	g) Review/Signing Agreements	Other-MOU	Modified
186512	f) State Notification to SSA of Deceased Claimant	Other-Internet Screens	Modified
186510	e) State Computation of Reimbursement Due from SSA Using Paper Form SSA-L8125 or eIAR	Form and Instruction	Modified	Supplemental Security Income Notice of Interim Assistance Reimbursement
186510	e) State Computation of Reimbursement Due from SSA Using Paper Form SSA-L8125 or eIAR	Other-Revised Privacy Act Statement	Modified
186508	d) State Request for Determination--Dispute Resolution		Modified
186507	c) State Notification to SSA of Amount of Reimbursement	Other-Internet Screens	Modified
186506	b) State Submission of Copy of Authorization (Manual Process)	Other-Sample MOU	Modified

ICR Details

OMB Control No: 0960-0546	ICR Reference No: 202007-0960-004
Status: Active	Previous ICR Reference No: 201703-0960-019
Agency/Subagency: SSA	Agency Tracking No:
Title: SSI Notice of Interim Assistance Reimbursement (IAR)
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: 05/15/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/06/2020
Terms of Clearance: The agency provided additional detail regarding the use of the information collection and means of submission. Approved consistent with the agency's commitments under Sec. 4 (k)(iii) and (iv) of E.O. 14058. As soon as reasonably possible, the agency will conduct a further non-substantive change to make further clarifying revisions to the Supporting Statement A

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved	05/31/2024
Responses	459,501	0	637,160
Time Burden (Hours)	32,170	0	45,216
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1631(g) of the Social Security Act authorizes SSA to reimburse an IAR agency from an individual’s retroactive Supplemental Security Income (SSI) payment for assistance the IAR agency gave the individual for meeting basic needs while an SSI claim was pending or SSI payments were suspended or terminated. The State or local agency needs an IAR agreement with SSA to participate in the IAR program. The individual receiving the IAR payment signs an authorization form with an IAR agency to allow SSA to repay the IAR agency for funds paid in advance prior to SSA’s determination on the individual’s claim. The authorization represents the individual’s intent to file for SSI, if they did not file an application prior to SSA receiving the authorization. Agencies who wish to enter into an IAR agreement with SSA needs to meet the following requirements: • Reporting Requirements - Each IAR agency agrees to: (a) notify SSA of receipt of an authorization for initial claims or cases they are appealing, and (b) submit a copy of that authorization either through a manual or electronic process; (c) inform SSA of the amount of reimbursement; (d) submit a written request for dispute resolution on a determination; (e) notify SSA of interim assistance paid (using the SSA–8125 or the SSA– L8125–F6); (f) inform SSA of any deceased claimants who participate in the IAR program and ; (g) review and sign an agreement with SSA. • Recordkeeping Requirements (h & i) – the IAR agencies agree to retain all notices, agreement, authorizations, and accounting forms for the period defined in the IAR agreement for the purposes of SSA verifying transactions covered under the agreement. • Third Party Disclosure Requirements (j): Each participating IAR agency agrees to send written notices from the IAR agency to the recipient regarding payment amounts and appeal rights. • Periodic Review of Agency Accounting Process (k-m) – the IAR agency makes the IAR accounting records of paid cases available for SSA review and verification. SSA conducts reviews either onsite or through the mail of the authorization forms, notices to the claimant and accounting forms. Upon completion of the review, SSA provides a written report of findings to the IAR agency director. The respondents are State IAR officers.

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Authorizing Statute(s): None

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:
	85 FR 45723	07/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 60509	09/25/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
a) State Notification of Receipt of Authorization (Electronic Process)
b) State Submission of Copy of Authorization (Manual Process)
c) State Notification to SSA of Amount of Reimbursement
d) State Request for Determination--Dispute Resolution
e) State Computation of Reimbursement Due from SSA Using Paper Form SSA-L8125 or eIAR	SSA-L8125-F6	Supplemental Security Income Notice of Interim Assistance Reimbursement
f) State Notification to SSA of Deceased Claimant
g) Review/Signing Agreements
h) Maintenance of Authorization Forms
i) Maintenance of Accounting Forms and Notices
j) Written Notice from State to Recipient Regarding Amount of Payment
k) Retrieve and Consolidate Authorization and Accounting Forms
l) Participate in Periodic Review
m) Correct Administrative and Accounting Discrepancies

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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	459,501	637,160	0	0	-177,659	0
Annual Time Burden (Hours)	32,170	45,216	0	0	-13,046	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 2017, the burden was 45,216 hours. However, we are currently reporting a burden of 32,170 hours. This change stems from a decrease in the number of responses from 2016 to 2019. 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. These figures represent current Management Information data.

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Annual Cost to Federal Government: $352,702

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? No

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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: 10/06/2020

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