View Information Collection Request (ICR) Package
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0069
ICR Reference No:
198503-0960-014
Status:
Historical Active
Previous ICR Reference No:
198408-0960-027
Agency/Subagency:
SSA
Agency Tracking No:
Title:
REPRESENTATIVE PAYEE EVALUATION REPORT
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:
06/10/1985
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/13/1985
Terms of Clearance:
APPROVED WITH THE FOLLOWING CONDITION:IN HHS'S NEXT REQUEST FOR CLEAR ANCE,HHS WILL INCLUDE A DETAILED ANALYSIS (COMPARING FY85 AND 1st AND 2nd QUARTER S OF FY86 DATA) OF:(1)HOW EFFECTIVE THE 624 IS IN DETECTIN THE MISHANDLING OF FUNDS,INCLUDING THE ACTUAL NUMBER OF INDIVIDUALS WH WERE REQUIRED TO USE THE 624,HOW EACH CASE WAS RESOLVED AND HOW MANY I IVIDUALS WERE REMOVED AS REP PAYEES AS A RESULT OF 624 INFORMATION (AN WITHOUT THRID PARTY REFERENCES),(2)THE NUMBER OF THRID PARTY REFERENCE (THOSE THAT LEAD TO 624 USAGE AND THOSE THAT DID NOT) AND THE DISPOS ITION OF THOSE CASES, INCLUDING THE NUMBER OF INDIVIDUALS WHO WERE RE MOVED AS REP PAYEES, (3)A DESCRIPTION OF "UNACCEPTABLE" RESPONSES RE QUIRING FOLLOWUP,AND WHAT RECOURSE IS TAKEN IN INSTANCES OF UNACCEPTAB RESPONSES, AND(4)THE STAFF,FTEs,AND DOLLARS INVOLVED IN THE ADMINISTRA TION OF THE 623 AND 624 (ALL STAGES OF THE OPERATION).IN ADDITION, SSA SHALL DEVELOP DATA ON THE COSTS AND BENEFITS OF ALTERNATIVE METHODS OF IDENTIFYING MISHANDLERS OF FUNDS (INCLUDING ALTERNATIVES SUCH AS PRO FILING MISHANDLERS AND UTILIZING ONLY THRID PARTY INFORMATION) AND PROVIDE THIS INFORMATION WITH ANY REQUEST FOR EXTENTION OF APPROVAL.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/1986
06/30/1986
03/31/1985
Responses
684,000
0
70,000
Time Burden (Hours)
342,000
0
35,000
Cost Burden (Dollars)
0
0
0
Abstract:
THE INFORMATION COLLECTED BY USE OF THE FORM SSA-624 IS NEEDED TO ACCURATELY ACCOUNT FOR THE USE OF SOCIAL SECURITY BENEFITS AND SUPPLEMENTAL SECURITY INCOME PAYMENTS THAT REPRESENTATIVE PAYEES RECEIVE ON BEHALF OF AN INDIVIDUAL. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS WHO WERE PREVIOUSLY SENT FORM SSA-623, REPRESENATIVE PAYEE REPORT, AND FAILED TO RETURN THE SSA-623 OR DID NOT COMPLETE THE THE FORM PROPERLY.
Authorizing Statute(s):
None
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
REPRESENTATIVE PAYEE EVALUATION REPORT
SSA-624
ICR Summary 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
684,000
70,000
0
0
614,000
0
Annual Time Burden (Hours)
342,000
35,000
0
0
307,000
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:
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Common Form ICR:
No
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:
03/13/1985
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