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:
0960-0019
ICR Reference No:
202201-0960-001
Status:
Active
Previous ICR Reference No:
201810-0960-013
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody
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:
04/18/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/31/2022
Terms of Clearance:
No later than one year prior to resubmission of this information collection for triannual renewal, the agency will evaluate, and share with OMB the results of the evaluation, the capacity to electronically receive and process this form through eSubmit or an alternative electronic submission method.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2026
36 Months From Approved
04/30/2023
Responses
390
0
14,000
Time Burden (Hours)
228
0
2,333
Cost Burden (Dollars)
0
0
0
Abstract:
SSA uses Form SSA-781 to determine if non-custodial parents who file for spouse, mother’s, father’s, or surviving divorced mother’s or father’s benefits based on having a child in their care, meet the “in-care” requirements. The in-care provision requires claimants to have an entitled child under age 16, or disabled in their care. The respondents are applicants for spouse; mother’s; father’s, or surviving divorced mother’s or father’s Social Security benefits.
Authorizing Statute(s):
US Code:
42 USC 402
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:
87 FR 13783
03/10/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 31598
05/24/2022
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
Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody
SSA-781
Certificate of Responsibility for Welfare Care of a Child Not in Applican'ts Custody
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
390
14,000
0
0
-13,610
0
Annual Time Burden (Hours)
228
2,333
0
0
-2,105
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 2019, the burden was 2,333 hours. However, we are currently reporting a burden of 33 hours. This change stems from a decrease in the number of responses from 14,000 to 390. In addition, we have decreased the completion time of the form from 10 minutes to 5 minutes. In previous clearances, we had no means in place to track or furnish definitive figures. However, we are now able to track Management Information (MI) data for this collection. Due to this, we have adjusted our number of responses and time burden estimates according to our MI data. Note: The total burden reflected in ROCIS is 228, while the burden cited in #12 of the Supporting Statement is 33. 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:
$55,018
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:
05/31/2022
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