View Information Collection Request (ICR) Package
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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:
0960-0444
ICR Reference No:
200909-0960-004
Status:
Historical Active
Previous ICR Reference No:
200907-0960-001
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Application for Supplemental Security Income
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:
09/18/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/17/2009
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2012
05/31/2012
05/31/2012
Responses
967,531
0
967,531
Time Burden (Hours)
238,900
0
238,900
Cost Burden (Dollars)
0
0
0
Abstract:
PL 110-328, The SSI Extension for Disabled and Elderly Refugees Act, temporarily extends the 7-year SSI eligibility period for certain refugees, asylum seekers, and other humanitarian immigrants, including victims of human trafficking, to 9 years. The 2-year extension applies to those aliens who were suspended or terminated from August 22, 1996 to September 30, 2008, due to the expiration of the 7-year eligibility period. SSA plans to add five prompts to a page in the SSI MSSICS screens in order to collect information about this category of refugees, asylum seekers, and other humanitarian immigrants. The documentation is used to support additional payments to certain refugees, asylum seekers, and other humanitarian immigrants. Please see the "Add/Edit Supporting Statement and Other Documents" page for details.
Authorizing Statute(s):
US Code:
42 USC 1383
Name of Law: Social Security Act
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
60-day Notice:
Federal Register Citation:
Citation Date:
73 FR 75488
12/11/2008
30-day Notice:
Federal Register Citation:
Citation Date:
74 FR 7506
02/17/2009
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Application for Supplemental Security Income
SSA-8001-BK
Application For Supplemental Security Income
Application for Supplemental Security Income MSSICS
Application for Supplemental Security Income MSSICS/Signature Proxy
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
967,531
967,531
0
0
0
0
Annual Time Burden (Hours)
238,900
238,900
0
0
0
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:
We are increasing the total annual burden to reflect the addition of the additional financial permissions questions to both the paper and MSSICS versions of this form. SSA estimates it will take the respondent an average of one minute to complete the financial permission (which includes time for our staff to explain the permission), for an estimated increase in the burden by 16,125 hours. Therefore, the new estimated annual burden for this ICR is 255,025.
Annual Cost to Federal Government:
$149,002
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)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov
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:
09/17/2009
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