View Information Collection Request (ICR) Package

OMB Control No: 0960-0014	ICR Reference No: 200805-0960-015
Status: Historical Active	Previous ICR Reference No: 200608-0960-016
Agency/Subagency: SSA	Agency Tracking No:
Title: Request to be Selected as Payee 20 CFR 404.2010-.2025, 414.582-.583, 416.601-.665
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: 05/20/2008
	Date Received in OIRA: 05/19/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2009	01/31/2009	01/31/2009
Responses	1,500,000	0	1,500,000
Time Burden (Hours)	248,333	0	248,333
Cost Burden (Dollars)	0	0	0

Abstract: The information established by the form is necessary to determine the proper payee for a Social Security beneficiary. The form is designed to aid the investigation of a payee applicant. The use of the form will establish the applicant's relation to the beneficiary, his/her justification and his/her concern for the beneficiary, as well as the manner in which the benefits will be used. The respondents are applicants for selection as representawtive payee for Title II, VIII, XVI and Black Lung.

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
Annual Number of Responses	1,500,000	1,500,000
Annual Time Burden (Hours)	248,333	248,333
Annual Cost Burden (Dollars)	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: The Request to be Selected as Payee 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 savings achieved through this collection and all other application in the Signature Proxy Initiative. In addition, Based on the latest management information of this forms usage, SSA is also adjusting the total number of annual respondents to the SSA-11 from 2,121,686 to 1,500,000.

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

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