View Information Collection Request (ICR) Package
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View Information Collection (IC) List
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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:
201812-0960-004
Status:
Historical Active
Previous ICR Reference No:
201602-0960-014
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Request to be Selected as a 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:
06/10/2019
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/27/2019
Terms of Clearance:
In accordance with 5 CFR 1320, the information collection is approved for three years.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2022
36 Months From Approved
08/31/2019
Responses
1,975,580
0
1,700,000
Time Burden (Hours)
395,116
0
311,666
Cost Burden (Dollars)
0
0
0
Abstract:
SSA requires individuals applying to be representative payees for OASDI, or SSI recipients to complete Form SSA-11-BK or, supply the same information to a field office technician through a personal interview. SSA obtains information from applicant payees regarding their relationship to the recipient; personal qualifications; concerns for the recipient’s well-being; and intended use of payments if appointed as payee. SSA collects this on paper Form SSA-11-BK, or through eRPS, an electronic version of the form, which field office technicians complete during a face-to-face interview with the applicant. The respondents are individuals; private sector businesses and institutions; and State and local government institutions and agencies applying to become representative payees.
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
PL:
Pub.L. 115 - 165 103(a) & 104
Name of Law: Strengthening Protections for Social Security Act of 2018
Citations for New Statutory Requirements:
PL: Pub.L. 108 - 203 103 & 203 Name of Law: Social Security Protection Act of 2004
PL: Pub.L. 115 - 165 103(a) & 104 Name of Law: Strengthening Protections for Social Security Act of 2018
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:
84 FR 371
01/25/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 11625
03/27/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
6
IC Title
Form No.
Form Name
Individuals/Households: Paper SSA-11-BK
SSA-11-BK
Request to be Selected as a Payee
Individuals/Households: Representative Payee System (RPS)
Private Sector: Paper SSA-11-BK
SSA-11-BK
Request to be Selected as Payee
Private Sector: RPS
State/Local/Tribal Government: Paper SSA-11-BK
SSA-11-BK
Request to be Selected as a Payee
State/Local/Tribal Government: RPS
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
1,975,580
1,700,000
0
0
275,580
0
Annual Time Burden (Hours)
395,116
311,666
0
0
83,450
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:
When we last cleared this IC in 2016, the burden was 311,666 hours. However, we are currently reporting a burden of 395,116. This change stems from SSA adding two additional questions to identify whether a child is in foster care and whether the applicant to be payee is a State Foster Care Agency due to the Public Law. There is no change to the burden time per response
Annual Cost to Federal Government:
$10,047,799
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
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]?
No
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:
03/27/2019
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