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:
0960-0648
ICR Reference No:
202111-0960-005
Status:
Active
Previous ICR Reference No:
201807-0960-002
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Credit Card Payment Form
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:
06/14/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/19/2021
Terms of Clearance:
When the agency seeks triannual renewal of this information collection, it will ensure that it provides a business process for respondents to electronically submit credit card payments for any type of service covered by this information collection. It can consider, for example, accepting payment through a separate or third-party payment tool (e.g. pay.gov) and provide respondents to this form the ability to transcribe the unique confirmation number correspondent to the pay.gov payment to facilitate validation of the payment. If the agency determines it is incapable of facilitating web-based credit card payments, it will provide a memo to OMB, signed by a Deputy Commissioner, that addresses the following factors: 1) The specific business process that prohibit the agency from using an internal or third-party payment processor. This will include describe the role, responsibility, and permissions of each individual who would be involved in processing this form. 2) Whether there are (and what are the) technical or information technology limitations that prevent the agency from processing electronic information. 3) Whether accepting handwritten credit card information reflects financial information best practices and is consistent with both government and industry standards related to protecting and processing financial information, with specific reference to the relevant industry or government standards (and a fact-specific explanation as to why this form satisfies these standards). 4) An estimation of the cost of developing a business process or information technology system for accepting online payment.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2026
36 Months From Approved
06/30/2023
Responses
6,000
0
6,000
Time Burden (Hours)
200
0
200
Cost Burden (Dollars)
0
0
0
Abstract:
SSA uses Form SSA-1414 to process: (1) Credit card payments from former employees and vendors who have outstanding debts owed to the agency; (2) advance payments for reimbursable agreements; and (3) credit card payment for all Freedom of Information Act (FOIA) requests requiring payment. The respondents are former employees, and vendors who have outstanding debts to the agency; entities who have reimbursable agreements with SSA; and individuals who request information through FOIA.
Authorizing Statute(s):
US Code:
42 USC 902
Name of Law: 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:
86 FR 47190
08/23/2021
30-day Notice:
Federal Register Citation:
Citation Date:
86 FR 64585
11/19/2021
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Credit Card Payment Form
SSA-1414
Credit Card Payment Form
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
6,000
6,000
0
0
0
0
Annual Time Burden (Hours)
200
200
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:
$352,920
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
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:
11/19/2021
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