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: 0960-0019	ICR Reference No: 202603-0960-005
Status: Active	Previous ICR Reference No: 202201-0960-001
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: 09/16/2026
	Date Received in OIRA: 04/27/2026
Terms of Clearance: Prior to triannual renewal, the agency is encouraged to correct and simplify its response to Question 3 to more clearly indicate that the agency accepts a fully electronic version of this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2029	36 Months From Approved	09/30/2026
Responses	478	0	390
Time Burden (Hours)	279	0	228
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	478	390	88
Annual Time Burden (Hours)	279	228	51
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 IC in 2023, the burden was 33 hours. However, we are currently reporting a burden of 40 hours. This change stems from an increase in the number of responses from 390 to 478. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. * Note: The total burden reflected in ROCIS is 279, while the burden cited in #12 of the Supporting Statement is 40. This discrepancy is because the ROCIS burden reflects the following components: field office/telephone 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: $6,171

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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