View Information Collection Request (ICR) Package

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: 0960-0814	ICR Reference No: 201907-0960-005
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Advance Designation of Representative Payee
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Preapproved	Conclusion Date: 01/10/2020
	Date Received in OIRA: 11/26/2019
Terms of Clearance: This collection is approved pursuant to 5 CFR 1320.11(g). The agency may collect the information upon finalization of the rulemaking without resubmitting to OMB, unless the collection has substantively or materially changed (see 5 CFR 1320.11(h)).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	36 Months From Approved
Responses	11,739,165	0	0
Time Burden (Hours)	1,173,917	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Request	Change Due to New Statute
Annual Number of Responses	11,739,165	11,739,165
Annual Time Burden (Hours)	1,173,917	1,173,917
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: To accommodate the new regulations, we created a new form, the SSA-4547. The new Form SSA-4547 increases the public reporting burden.

Annual Cost to Federal Government: $27,884,181

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

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