Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records
No material or nonsubstantive change to a currently approved collection
No
Regular
Approved without change
05/01/2026
04/03/2026
Consistent with OMB communications with the agency, the agency will work with OMB to update the discussion of the non-substantive change request via a second non-substantive change request.
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
11/30/2027
11/30/2027
11/30/2027
30,227,327
0
16,230,000
1,670,247
0
1,381,666
0
0
0
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 individualâs 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 individualâs 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.
We are submitting a non-substantive Change Request to request to add a new modality of completion for the SSA-4641. The new version will be published as an overprint (SSA-4641 OP1) and will not replace any existing modalities, we are updating disclosures and the Privacy Act Statement and we are moving the financial account identification from the authorization portion of the form to a new Part Two of the form and broken up the various parts of this multipurpose form into four sections.
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.
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.
Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records - Individuals (Paper and Electronic)