Statement of Care and Responsibility for Beneficiary

ICR 202108-0960-011

OMB: 0960-0109

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2021-08-24
Supporting Statement A
2021-09-03
IC Document Collections
IC ID
Document
Title
Status
43697 Modified
ICR Details
0960-0109 202108-0960-011
Received in OIRA 201803-0960-008
SSA
Statement of Care and Responsibility for Beneficiary
Revision of a currently approved collection   No
Regular 09/03/2021
  Requested Previously Approved
36 Months From Approved 10/31/2021
130,000 130,000
21,667 21,667
0 0

SSA uses the information from Form SSA-788 to verify payee applicants' statements of concern and to identify other potential payees. SSA is concerned with selecting the most qualified representative payee who will use Social Security benefits in the beneficiary's best interest. SSA considers factors such as the payee applicant's capacity to perform payee duties, awareness of the beneficiary's situation and needs, demonstration of past and current concern for the beneficiary's well-being, etc. If the payee applicant does not have custody of the beneficiary, SSA will obtain information from the custodian for evaluation against information provided by the applicant. Respondents are individuals who have custody of the beneficiary in cases where someone else has filed to be the beneficiary's representative payee. Form SSA-788 is an agency generated form, which SSA completes the top portion of Form SSA-788, sends to the custodians of the beneficiaries, and they complete the rest of the form and gives back to us.

US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 1007 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  86 FR 35371 07/02/2021
86 FR 49403 09/02/2021
No

1
IC Title Form No. Form Name
Statement of Care and Responsibility for Beneficiary SSA-788 Statement of Care and Responsibility for Beneficiary

  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 130,000 130,000 0 0 0 0
Annual Time Burden (Hours) 21,667 21,667 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$494,620
No
    Yes
    Yes
No
No
No
No
Faye Lipsky 410 965-8783 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/03/2021


© 2021 OMB.report | Privacy Policy