View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0960-0529	ICR Reference No: 202106-0960-003
Status: Historical Active	Previous ICR Reference No: 201805-0960-012
Agency/Subagency: SSA	Agency Tracking No:
Title: Claimant Statement About Loan of Food or Shelter; Statement about Food or Shelter Provided to Another
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/12/2024
	Date Received in OIRA: 09/30/2021
Terms of Clearance: The agency provided substantially more detail in the supporting statement explaining the operation of this information collection and the need for the information. The agency also revised the burden estimate upwards and made minor revisions to the form to clarify when estimating dates and loan amounts is appropriate. Prior to triannual renewal, the agency will allow for electronic submission of this information collection or will upload a separate document in which the agency provides a fact-specific justification for why this information collection cannot be signed and filed electronically and why this is consistent with the agency's commitments under Sec. 4 (k)(iii) and (iv) of E.O. 14058.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2027	36 Months From Approved	08/31/2024
Responses	116,104	0	122,528
Time Burden (Hours)	152,870	0	20,420
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	116,104	122,528	-6,424
Annual Time Burden (Hours)	152,870	20,420	132,450
Annual Cost Burden (Dollars)	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 collection in 2018 the burden was 20,420 hours. However, we are currently reporting a burden of 48,376 hours. This change stems from a decrease in the number of responses from 122,528 to 116,104, due to fewer respondents applying for food and shelter assistance. Although the number of responses changed, SSA did not take any actions to cause this change. In addition, we are also increasing the burden per response based on current MI data which shows it takes longer for respondents to learn about the program, gather the information, and complete the information collection. The updated figure represents current MI data. * Note: The total burden reflected in ROCIS is 152,870, while the burden cited in #12 of the Supporting Statement is 48,376. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

Annual Cost to Federal Government: $413,606

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? No

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

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