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OMB Control No: 0960-0004	ICR Reference No: 200608-0960-018
Status: Historical Active	Previous ICR Reference No: 200310-0960-011
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Widow's or Widower's Insurance Benefits 20 CFR 404.335-.338, 20 CFR 404.603
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/2006
	Date Received in OIRA: 09/01/2006
Terms of Clearance: OMB approves this burden reduction due to SSA's implementation of the Signature Proxy initiative.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2006	12/31/2006	12/31/2006
Responses	288,580	0	288,580
Time Burden (Hours)	69,860	0	72,145
Cost Burden (Dollars)	0	0	0

Abstract: The Social Security Administration uses the information collected on Form SSA-10-BK to determine whether the applicant meets the statutory and regulatory condition for entitlement to widow(er)'s Social Security Title II benefits. The respondents are applicants for widow(er)'s Social Security benefits.

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	288,580	288,580	0
Annual Time Burden (Hours)	69,860	72,145	-2,285
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The Application for Widow's or Widower's Insurance Benefits, SSA-10-BK is one of the collections cited under our ICB burden reduction Initiative Signature Proxy. The Signature Proxy Initiative is an alternative to the traditional pen and ink or wet signature, and it eliminates the need to retain paper applications in most circumstances by allowing the technician to process the application on the claimants behalf, without a signature. In most instances, Signature Proxy allows SSA to store and process the entire benefit application electronically, thus reducing costs associated with mailing and storing physical files. In addition, the adoption of Signature Proxy supports faster processing of claims and will improve service to the public by eliminating the need to mail the application to the claimant and wait for it to be signed and returned. Please see the attached Supplementary Documentation which outlines the burden saving achieved through this collection and all other application in the Signature Proxy Initiative.

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

Agency Contact: Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov

View ICR - OIRA Conclusion