Report of Deceased Individual's Social Security Record

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-711 Report of Deceased Individual's Social Security Record	Form	Modified	Available
Supporting Statement - 0665.docx	Supporting Statement A	Uploaded 2020-10-06	Available
Justification for the Non-Substantive Changes - 0665.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-10-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43711	Report of Deceased Individual's Social Security Record	Form	Modified
189491	Request for Deceased Individual's Social Security Record	Other-Internet Screens	Unchanged

ICR Details

OMB Control No: 0960-0665	ICR Reference No: 202009-0960-013
Status: Active	Previous ICR Reference No: 201805-0960-014
Agency/Subagency: SSA	Agency Tracking No:
Title: Report of Deceased Individual's Social Security Record
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: 10/16/2020
	Date Received in OIRA: 10/08/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	10/31/2021	10/31/2021
Responses	50,000	0	50,000
Time Burden (Hours)	5,833	0	5,833
Cost Burden (Dollars)	0	0	0

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Abstract: When a member of the public requests an individual’s Social Security record, SSA needs the name and address of the requestor as well as a description of the requested record to process the request. SSA uses the information the respondent provides on Form SSA-711, or via an internet request through SSA’s electronic Freedom of Information Act (eFOIA) website, to: (1) verify the wage earner is deceased; and (2) access the correct Social Security record. Respondents are members of the public requesting deceased individuals’ Social Security records. We are submitting this non-substantive Change Request to change the fees listed on the form.

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Authorizing Statute(s): US Code: 5 USC 552 Name of Law: Public Information; agency rules, opinions, orders, records, and proceedings
   PL: Pub.L. 114 - 185 337 Name of Law: Freedom of Information Act (FOIA)
  

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 26732	07/08/2018
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: 2

table that charts list of burden

IC Title	Form No.	Form Name
Report of Deceased Individual's Social Security Record	SSA-711	Request for Deceased Individual's Social Security Record
Request for Deceased Individual's Social Security Record

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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	50,000	50,000	0	0	0	0
Annual Time Burden (Hours)	5,833	5,833	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:

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Annual Cost to Federal Government: $585,000

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: 10/08/2020

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