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:
0960-0014
ICR Reference No:
201003-0960-009
Status:
Historical Active
Previous ICR Reference No:
200808-0960-009
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Request to be Selected as Payee
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:
09/15/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/05/2010
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2013
36 Months From Approved
03/31/2012
Responses
1,500,000
0
1,500,000
Time Burden (Hours)
248,335
0
248,335
Cost Burden (Dollars)
0
0
0
Abstract:
An individual applying to be a representative payee for a Social Security, Supplemental Security Income, or Special Veteran's benefit recipient completes Form SSA11BK. SSA designed the form to aid our investigation of a payee applicant. These investigations obtain information from applicant payees regarding their relationship to the beneficiary, personal qualifications, their concern for the beneficiary's well-being, and their intended use of benefits if appointed as payee. The respondents are individuals, private sector businesses and institutions, and state and local government institutions and agencies.
Authorizing Statute(s):
US Code:
42 USC 405
Name of Law: Social Security Act
US Code:
42 USC 1383
Name of Law: Social Security Act
PL:
Pub.L. 108 - 203 103 & 203
Name of Law: Social Security Protection Act of 2004
Citations for New Statutory Requirements:
PL: Pub.L. 108 - 203 103 & 203 Name of Law: Social Security Protection Act of 2004
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 27036
05/13/2010
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 45190
08/02/2010
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
9
IC Title
Form No.
Form Name
Individuals/Households: Paper SSA-11-BK
SSA-11-BK
Request to be Selected as Payee
Individuals/Households: Representative Payee System (RPS)
Individuals/Households: Representative Payee System (RPS)/Signature Proxy
Private Sector: Paper SSA-11-BK
SSA-11-BK
Request to be Selected as Payee
Private Sector: RPS
SSA-11 RPS Screens
Request to be Selected as Payee
Private Sector: RPS/Signature Proxy
SSA-11 RPS Screens
Request to be Selected as Payee
State/Local/Tribal Government: Paper SSA-11-BK
SSA-11-BK
Request to be Selected as Payee
State/Local/Tribal Government: RPS
SSA-11 RPS Screens
Request to be Selected as Payee
State/Local/Tribal Government: RPS/Signature Proxy
SSA-11 RPS Screens
Request to be Selected as Payee
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
1,500,000
1,500,000
0
0
0
0
Annual Time Burden (Hours)
248,335
248,335
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:
Annual Cost to Federal Government:
$4,612,500
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:
08/05/2010
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