Non-Substantive Change 0960-0776

Justification for Non-Substantive Changes for Form SSA-640

Financial Disclosure for a Civil Monetary Penalty Debt

20 CFR 498

OMB No. 0960-0776

Background

The Social Security Administration (SSA) uses Form SSA-640 to obtain information to determine a monthly installment repayment rate for individuals owing a civil monetary penalty who are requesting a change in their current payment arrangement. Currently, the paper and PDF versions of this form includes a signature requirement.

SSA recently reassessed the need for the respondent’s signature on this form and determined that we no longer require it. Therefore, we are removing the signature requirement from this form.

While we will leave the signature block on the form for those respondents who prefer to sign the form, we will not require a wet signature. Rather, we will make the signature block fillable to allow those who prefer to sign to type in their signature, rather than requiring them to print the form and sign it.

Revision to the Information Collection

• Change #1: SSA is removing the signature requirement from Form SSA-640.

Justification #1: We reassessed the need for a wet signature on this form and determined we no longer require it. Therefore, we will no longer ask respondents to sign this form prior to submitting it to SSA.

After OMB approves the signature removal for this form, we will implement the new version of the form that clarifies that we no longer require a signature by making the signature block on the form fillable.

This action will not affect the public reporting burden.