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OMB Control No: 0960-0776	ICR Reference No: 202606-0960-003
Status: Received in OIRA	Previous ICR Reference No: 202504-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Financial Disclosure for Civil Monetary Penalty (CMP) Debt
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 06/26/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	10	10
Time Burden (Hours)	30	25
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	10	10	0
Annual Time Burden (Hours)	30	25	5
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: There are no changes to the public reporting burden. However, the burden shown in ROCIS has changed minorly – see note below. *Note: The total burden reflected in ROCIS is 30, while the burden cited in #12 of the Supporting Statement is 20. 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 above reflects actual burden. In addition, we are showing a minor burden change of 5 minutes in ROCIS due to fluctuations in the field office wait time and the addition of the learning cost.

Annual Cost to Federal Government: $4,595

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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