Notice Regarding Substitution of Party Upon Death of Claimant

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HA-539 Notice Regarding Substitution of Party Upon Death of Claimant	Form	Modified	Available
Form HA-539 Notice Regarding Substitution of Party Upon Death of Claimant	Form	Modified	Repair queued
Addendum - 0288.docx	Supplementary Document	Uploaded 2021-07-30	Available
Addendum - 0288.docx	Supplementary Document	Uploaded 2021-07-30	Repair queued
Supporting Statement - 0960-0288 (final).docx	Supporting Statement A	Uploaded 2024-07-24	Available
Supporting Statement - 0288 (final).docx	Supporting Statement A	Uploaded 2021-09-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9191	Notice Regarding Substitution of Party Upon Death of Claimant	Form	Modified	Notice Regarding Substitution of Party Upon Death of Claimant
9191	Notice Regarding Substitution of Party Upon Death of Claimant	Form	Modified
9191	Notice Regarding Substitution of Party Upon Death of Claimant	Other-Cover Letter	Modified

ICR Details

OMB Control No: 0960-0288	ICR Reference No: 202107-0960-009
Status: Active	Previous ICR Reference No: 201807-0960-010
Agency/Subagency: SSA	Agency Tracking No:
Title: Notice Regarding Substitution of Party Upon Death of Claimant
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: 08/12/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2021
Terms of Clearance: The agency made minor modifications to the Supporting Statement A to clarify triggering events which lead to the use of this form. The agency also uploaded a copy of the contemporary version of the form. Prior to triannual renewal, the agency will allow for electronic submission of this information collection or will upload a separate document in which the agency provides a fact-specific justification for why this information collection cannot be signed and filed electronically and why this is consistent with the agency's commitments under Sec. 4 (k)(iii) and (iv) of E.O. 14058.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2027	36 Months From Approved	08/31/2024
Responses	4,000	0	4,000
Time Burden (Hours)	333	0	333
Cost Burden (Dollars)	0	0	0

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Abstract: An ALJ may dismiss a request for a hearing on a pending claim of a deceased individual for Social Security benefits or Supplemental Security Income (SSI) payments. Individuals who believe they may be adversely affected by the dismissal may ask to be a substitute party for the deceased claimant by completing Form HA-539. The ALJs and the hearing office support staff use this form to (1) maintain a written record of the request; (2) establish the relationship of the requester to the deceased claimant; (3) determine the substituted individual's wishes regarding an oral hearing or decision on the record; and (4) admit the data into the claimant's official record as an exhibit. The respondents are individuals requesting to be a substitute party for a deceased claimant.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1383 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 40221	07/27/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 54007	09/29/2021
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
Notice Regarding Substitution of Party Upon Death of Claimant	HA-539	Notice Regarding Substitution of Party Upon Death of Claimant

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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	4,000	4,000	0	0	0	0
Annual Time Burden (Hours)	333	333	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: $15,017

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.     No

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: 09/30/2021

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