Child Relationship Statement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-2519 Child Relationship Statement	Form	Modified	Repair queued
Form SSA-2519 Child Relationship Statement	Form	Modified	Repair queued
Supporting Statement - 0116.docx	Supporting Statement A	Uploaded 2022-05-25	Repair queued
Addendum - 0116.docx	Supplementary Document	Uploaded 2019-01-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9088	Child Relationship Statement	Form	Modified	Child Relationship Statement
9088	Child Relationship Statement	Form	Modified

ICR Details

OMB Control No: 0960-0116	ICR Reference No: 202203-0960-003
Status: Active	Previous ICR Reference No: 201810-0960-016
Agency/Subagency: SSA	Agency Tracking No:
Title: Child Relationship Statement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/02/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/25/2022
Terms of Clearance: Prior to renewal, the agency will revise the Supporting Statement A, Question Prompt #2 to discuss in more detail (!) The circumstances under which it may be relevant for an insured individual to demonstrate that someone is their child for the purposes of SSA programs and (2) the reason why the specific questions asked on the form are relevant for SSA assessing this claim.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	36 Months From Approved	11/30/2023
Responses	50,000	0	50,000
Time Burden (Hours)	55,000	0	12,500
Cost Burden (Dollars)	0	0	0

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Abstract: To help determine a child’s entitlement to Social Security benefits, SSA uses criteria under section 216(h)(3) of the Social Security Act, deemed child provision. SSA may deem a child to an insured individual if: (1) the insured individual presents SSA with satisfactory evidence of parenthood, and was living with or contributing to the child’s support at certain specified times; or (2) the insured individual (a) acknowledged the child in writing; (b) was court decreed as the child’s parent; or (c) was court ordered to support the child. To obtain this information, SSA uses Form SSA-2519, Child Relationship Statement. Respondents are people with knowledge of the relationship between certain individuals filing for Social Security benefits and their alleged biological children.

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Authorizing Statute(s): US Code: 42 USC 416 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: 1

table that charts list of burden

IC Title	Form No.	Form Name
Child Relationship Statement	SSA-2519	Child Relationship Statement

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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	50,000	50,000	0	0	0	0
Annual Time Burden (Hours)	55,000	12,500	0	0	42,500	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 for this information collection. Note: The total burden reflected in ROCIS is 55,000, while the burden cited in #12 of the Supporting Statement is 1,245. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + telephone call system wait times + 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: $27,845

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: 05/25/2022

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