Statement Regarding Contributions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-783 Statement Regarding Contributions	Form and Instruction	Modified	Repair queued
Addendum - 0020.docx	Supplementary Document	Uploaded 2020-11-16	Repair queued
Supporting Statement - 0020.docx	Supporting Statement A	Uploaded 2020-11-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8915	Statement Regarding Contributions	Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0020	ICR Reference No: 202008-0960-012
Status: Received in OIRA	Previous ICR Reference No: 201704-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement Regarding Contributions
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/16/2020

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	2,352	30,000
Time Burden (Hours)	588	8,500
Cost Burden (Dollars)	0	0

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Abstract: SSA uses the SSA-783 to collect information regarding a child's current sources of support when determining the child's entitlement to Social Security benefits. We request this information from adults acting on behalf of the child claimants who can provide SSA with any sources of support or substantial contributions for the child. These adults inform the claims representative as part of the initial benefits process. If the individual capable of providing the information does not accompany the child claimant, we mail the SSA-783 to the individual for completion, or if the person has access to a computer, we will refer them to SSA's website. The respondents are individuals providing information about a child's sources of support.

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Authorizing Statute(s): US Code: 42 USC 416 Name of Law: Social Security Act
   US Code: 42 USC 402 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:
	85 FR 51536	08/20/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 70216	11/04/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Statement Regarding Contributions	SSA-783	Statement Regarding Contributions

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	2,352	30,000	0	0	-27,648	0
Annual Time Burden (Hours)	588	8,500	0	0	-7,912	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 information collection in 2017, the burden was 8,500 hours; however, we are currently reporting a burden of 588 hours. In the prior clearance package, we estimated 30,000 responses. We are updating the burden based on current management information data showing the number of annual responses for a recent twelve-month period was 2,352. 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: $29,568

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: 11/16/2020

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