Credit Card Payment Form

ICR 202111-0960-005

OMB: 0960-0648

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2021-11-15
Supporting Statement A
2021-11-19
IC Document Collections
IC ID
Document
Title
Status
9686 Modified
ICR Details
0960-0648 202111-0960-005
Received in OIRA 201807-0960-002
SSA
Credit Card Payment Form
Revision of a currently approved collection   No
Regular 11/19/2021
  Requested Previously Approved
36 Months From Approved 12/31/2021
6,000 6,000
200 200
0 0

SSA uses Form SSA-1414 to process: (1) Credit card payments from former employees and vendors who have outstanding debts owed to the agency; (2) advance payments for reimbursable agreements; and (3) credit card payment for all Freedom of Information Act (FOIA) requests requiring payment. The respondents are former employees, and vendors who have outstanding debts to the agency; entities who have reimbursable agreements with SSA; and individuals who request information through FOIA.

US Code: 42 USC 902 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  86 FR 47190 08/23/2021
86 FR 64585 11/19/2021
No

1
IC Title Form No. Form Name
Credit Card Payment Form SSA-1414 Credit Card Payment Form

  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 6,000 6,000 0 0 0 0
Annual Time Burden (Hours) 200 200 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$352,920
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.
11/19/2021


© 2021 OMB.report | Privacy Policy