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OMB Control No: 0960-0635	ICR Reference No: 202608-0960-010
Status: Received in OIRA	Previous ICR Reference No: 202110-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Function Report - Adult Third Party
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/24/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	635,620	709,700
Time Burden (Hours)	699,182	721,528
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	635,620	709,700	-74,080
Annual Time Burden (Hours)	699,182	721,528	-22,346
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 721,528 hours. However, we are currently reporting a burden of 646,214 hours. This change stems from a decrease in the number of responses and an increase in burden time per response. Responses decreased from 709,700 to 635,620. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. In addition, the burden time increased by five minutes per response due to learning costs that we did not include in our last theoretical burden calculation. *Note: The total burden reflected in ROCIS is 6,99,182, while the burden cited in #12 of the Supporting Statement is 646,214. This discrepancy is because the ROCIS burden reflects the learning costs. In contrast, the chart in #12 above reflects actual burden.

Annual Cost to Federal Government: $7,687,765

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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