Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records

Forms and Documents

Document Name	Status
Form SSA-4641 Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records - Individuals (Paper and Electronic) Form and Instruction	Modified
Form SSA-4641 Authorization for SSA to Obtain Account Records From A Financial Institution And Request for Records - Financial Institutions (Paper) Form	Modified
Addendum - 0293 (Final).docx Supplementary Document	2022-05-25
Supporting Statement - 0293 (Final).docx Supporting Statement A	2022-05-31

IC Document Collections

IC ID	Document Title	Status
9201	Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records - Individuals (Paper and Electronic) Form and Instruction	Modified
253711	Authorization for SSA to Obtain Account Records From A Financial Institution And Request for Records - Financial Institutions (Electronic) Other-Electronic Screens	New
191430	Authorization for SSA to Obtain Account Records From A Financial Institution And Request for Records - Financial Institutions (Paper) Form	Modified

ICR Details

OMB Control No: 0960-0293	ICR Reference No: 202201-0960-009
Status: Received in OIRA	Previous ICR Reference No: 201810-0960-017
Agency/Subagency: SSA	Agency Tracking No:
Title: Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/31/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2022
Responses	16,230,000	16,000,000
Time Burden (Hours)	1,381,666	542,667
Cost Burden (Dollars)	0	0

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Abstract: SSA collects and verifies financial account information from individuals requesting a waiver of their Title II and Title XVI overpayments, as well as those who apply for, or currently receive (in the case of redetermination) Supplemental Security Income (SSI) payments. We require financial information from these individual’s to: (1) determine the eligibility of the applicant or recipient for SSI benefits; or (2) determine if a request to waive a Social Security overpayment defeats the purpose of the Act. If an individual provides incomplete or seemingly altered records, or if records are unavailable, SSA contacts his or her financial institutions to verify the existence; ownership; and value of accounts owned. Financial institutions need individuals to sign Form SSA-4641-F4, or contact SSA and use the Internet version, e4641, to authorize them to disclose the individual’s records to SSA. The respondents are Title II and Title XVI recipients applying for waivers, or SSI applicants, recipients, and their deemors to determine SSI eligibility.

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Authorizing Statute(s): PL: Pub.L. 114 - 74 834 Name of Law: Bipartisan Budget Act
   US Code: 12 USC 35, sections 3402-3404 Name of Law: Right to Financial Privacy Act of 1978
   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:
	87 FR 13783	03/10/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 31598	05/24/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records - Individuals (Paper and Electronic)	SSA-4641	Authorization for the Social Security Administration to Obtain Account Records from a Financial Institution and Request for Records
Authorization for SSA to Obtain Account Records From A Financial Institution And Request for Records - Financial Institutions (Electronic)
Authorization for SSA to Obtain Account Records From A Financial Institution And Request for Records - Financial Institutions (Paper)	SSA-4641	Authorization for the Social Security Administration to Obtain Account Records from a Financial Institution and Request for Records

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ICR Summary of Burden

	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	16,230,000	16,000,000	0	0	230,000	0
Annual Time Burden (Hours)	1,381,666	542,667	0	0	838,999	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: When we last cleared this IC in 2019, the burden was 542,667 hours. However, we are currently reporting a burden of 599,166 hours. This change stems from our new way of categorizing respondents into different groups (individual respondents versus financial institution respondents). Specifically, there was an increase in the number of responses from 16,000,000 to 16,230,000. In addition, due to the new three classifying groups of respondents, the burden per response estimates is now 2, 4, and 6 minutes, instead of just 2 and 6 minutes from before. These figures represent current Management Information data. Note: The total burden reflected in ROCIS is 1,381,666, while the burden cited in #12 of the Supporting Statement is 599,166. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

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Annual Cost to Federal Government: $27,572,580

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: 05/31/2022

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