Certificate of Support

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-760 Certificate of Support	Form and Instruction	Modified	Available
Form SSA-760 Certificate of Support	Form and Instruction	Modified	Repair queued
Supporting Statement - 0001 (Final).docx	Supporting Statement A	Uploaded 2024-11-20	Available
Supporting Statement - 0001 (Final).docx	Supporting Statement A	Uploaded 2021-11-19	Repair queued
Addendum - 0001 (Final).docx	Supplementary Document	Uploaded 2021-11-19	Available
Addendum - 0001 (Final).docx	Supplementary Document	Uploaded 2021-11-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8859	Certificate of Support	Form and Instruction	Modified	Certificate of Support
8859	Certificate of Support	Form and Instruction	Modified
8859	Certificate of Support	Other-Revised PA & PRA Statements	Modified

ICR Details

OMB Control No: 0960-0001	ICR Reference No: 202105-0960-003
Status: Active	Previous ICR Reference No: 201807-0960-015
Agency/Subagency: SSA	Agency Tracking No:
Title: Certificate of Support
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: 12/19/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/19/2021
Terms of Clearance: In accordance with 5 CFR 1320, this information collection is approved.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2027	36 Months From Approved	12/31/2024
Responses	18,000	0	18,000
Time Burden (Hours)	9,000	0	4,500
Cost Burden (Dollars)	0	0	0

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Abstract: A parent of a deceased, fully insured worker may be entitled to Social Security Old Age, Survivors, and Disability Insurance (OASDI) benefits based on the earnings record of the deceased worker under certain conditions. One of the conditions is when the parent receives at least one-half support from the deceased worker at certain points in time. The one-half support requirement also applies to a spousal applicant in determining whether OASDI benefits are subject to GPO. SSA uses Form SSA-760 to determine if the parent of a deceased worker or a spouse applicant meets the one-half support requirement. This form is mailed to the claimant with an SSA addressed postage stamp envelop for the claimant to mail back to their Field Office (FO). Respondents are parents of deceased workers and spouses who may meet the GPO exception.

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Authorizing Statute(s): 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:
	86 FR 47190	08/23/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 64585	11/18/2021
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
Certificate of Support	SSA-760	Certificate of Support

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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	18,000	18,000	0	0	0	0
Annual Time Burden (Hours)	9,000	4,500	0	0	4,500	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: There are no changes to the public reporting burden. However, as per our agreement with OMB, we have increased the burden per response to 30 minutes, as the respondents need to recall expenses and income from a prior time period which may take more time. As we agreed to this adjustment, we updated the burden data accordingly.

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Annual Cost to Federal Government: $67,795

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: 11/19/2021

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