Waiver of Supplemental Security Income Payment Continuation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-263 Waiver of Supplemental Security Income Payment Continuation	Form and Instruction	Modified	Available
Form SSA-263 Waiver of Supplemental Security Income Payment Continuation	Form and Instruction	Modified	Repair queued
Supporting Statement - 0783 (Final).docx	Supporting Statement A	Uploaded 2022-10-04	Repair queued
Addendum - 0783 (Final).docx	Supplementary Document	Uploaded 2022-10-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
191692	Waiver of Supplemental Security Income Payment Continuation	Form and Instruction	Modified	Waiver of Supplemental Security Income Payment Continuation
191692	Waiver of Supplemental Security Income Payment Continuation	Form and Instruction	Modified
191692	Waiver of Supplemental Security Income Payment Continuation	Other-Revised PA & PRA Statements	Modified

ICR Details

OMB Control No: 0960-0783	ICR Reference No: 202204-0960-009
Status: Active	Previous ICR Reference No: 201904-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Waiver of Supplemental Security Income Payment Continuation
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: 07/20/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/04/2022
Terms of Clearance: The agency modified its burden estimate to account for the time of reviewing the notice; it uploaded a sample NOPA notice; and made minor modifications to the Supporting Statement A to further clarify the operational impacts related to the timing of a NOFO relative to benefits provision.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	36 Months From Approved	07/31/2023
Responses	3,676	0	3,000
Time Burden (Hours)	3,431	0	250
Cost Burden (Dollars)	0	0	0

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Abstract: The NOPA SSA sends to the recipient explains the waiver process, and how respondents can access Form SSA-263 to request a waiver. The SSA-263 collects the following information and acknowledgements from an SSI recipient: • the respondent’s name; • social security number; • acknowledgement that SSA may reduce, suspend, or terminate their SSI payment; • acknowledgement of the right to payment continuation; • acknowledgement of the right to request and receive payment continuation at any time before we make a determination on the appeal; • acknowledgement that we have explained the rights; and, • acknowledgement that the SSI recipient understands the rights concerning the waiver and receipt of payment continuation. SSI recipients may print the form on their own from SSA’s website or contact a field office to request the form. We use the SSA-263 to provide a modality through which an SSI recipient communicates to us that they do not wish to receive payment continuation. Waiver of payment continuation is voluntary. Therefore, SSI recipients complete the SSA-263 at their own discretion if they do not wish to receive payment continuation once they receive a NOPA from SSA to reduce, suspend, or terminate their SSI payment(s). SSI recipients complete the SSA-263 on their own or with the assistance from a field office technician. SSA uses the information we collect on the SSA-263 to process a waiver of payment continuation. The respondents for this collection are SSI recipients who receive a NOPA to reduce, suspend, or terminate their SSI payments.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: The 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 39153	06/30/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 57551	09/20/2022
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
Waiver of Supplemental Security Income Payment Continuation	SSA-263	Waiver of Supplemental Security Income Payment Continuation

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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	3,676	3,000	0	0	676	0
Annual Time Burden (Hours)	3,431	250	0	0	3,181	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 250 hours. However, we are currently reporting a burden of 306 hours. This change stems from an increase in the number of responses from 3,000 to 3,676. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. Note: The total burden reflected in ROCIS is 3,431, while the burden cited in #12 of the Supporting Statement is 306. This discrepancy is because the ROCIS burden reflects the following components: field office and teleservice center 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: $11,590

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: 10/04/2022

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