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:
0960-0780
ICR Reference No:
201001-0960-006
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Centenarian Project Development Worksheets: Face-to-Face Interview; Telephone Interview; Third Party Contact; Unable to Locate
Type of Information Collection:
Existing collection in use without an OMB Control Number
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/15/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/15/2010
Terms of Clearance:
OMB is approving this collection with the understanding that SSA will report the collection as a PRA violation with their next Information Collection Budget (ICB) submission.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2013
36 Months From Approved
Responses
14,000
0
0
Time Burden (Hours)
3,500
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
SSA is conducting interviews with centenary beneficiaries age 103 and older to : (1) determine if the beneficiaries are still living; (2) prevent fraud, through either identity misrepresentation or representative payee misuse of funds; and (3) assess the well-being of the beneficiaries. SSAs San Francisco field offices are currently using this survey and we intend to expand its use to all other SSA field offices. Field office personnel obtain the information through onetime, in-person interviews with centenarians. During the interview, SSA employees will make overall observations of the centenarian and their representative payee (if applicable). The interviewer will use the appropriate Centenarian Development Worksheet as a guide for the interview and to document findings. SSA will conduct the interview one time only at the beneficiarys residence or over the phone if a site visit is not possible. Refusal of the interview will not result in the suspension of the centenarians payments. Respondents are Supplemental Security Income recipients or Social Security beneficiaries 103 years old or older, their representative payees, or caregivers.
Authorizing Statute(s):
US Code:
42 USC 405
Name of Law: The Social Security Act
US Code:
42 USC 1383
Name of Law: The 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:
75 FR 4606
01/28/2010
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 15761
03/30/2010
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Centenarian Project Development Worksheets: Face-to-Face Interview; Telephone Interview; Third Party Contact; Unable to Locate
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
14,000
0
0
0
0
14,000
Annual Time Burden (Hours)
3,500
0
0
0
0
3,500
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:
This collection, currently in use without OMB approval, increases the public reporting burden. See #12 of the Supporting Statement, or the ICR Summary of Burden above for the burden figures.
Annual Cost to Federal Government:
$185,573
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]?
No
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:
Faye Lipsky 410 965-8783 faye.lipsky@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:
04/15/2010
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