Statement of Reclamation Action

Forms and Documents

Document Name	Status
Form SSA-1712 SSA-1713/Not-For-Profit Form and Instruction	New
Form SSA-1713 SSA-1713/businesses Form	New
SSA-1712-CN Cover Sheet.pdf Supplementary Document	2006-08-16
SSA-1712 Cover Sheet.pdf Supplementary Document	2006-08-16
Supporting Statement--SSA-1713.doc Supporting Statement A	2006-08-16
Addendum--SSA-1713.doc Supplementary Document	2006-07-27

IC Document Collections

IC ID	Document Title	Status
44359	SSA-1713/Not-For-Profit Form and Instruction	New
44357	SSA-1713/businesses Form	New

ICR Details

OMB Control No: 0960-0734	ICR Reference No: 200607-0960-013
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement of Reclamation Action
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/01/2006
	Date Received in OIRA: 08/22/2006
Terms of Clearance: OMB approves this previously unapproved collection. SSA must report the resolution of this violation in the next ICB, and expeditiously identify and resolve any additional violations to ensure full compliance with the PRA.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2009	36 Months From Approved
Responses	15	0	0
Time Burden (Hours)	1	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Form SSA-1713 collects information regarding whether, how and when a Canadian bank was able to return erroneous payments made after the death of a beneficiary who elected to have payments sent to Canada. The SSA-1713 is sent with the SSA-1712, an SSA-generated cover sheet which provides the Canadian bank with information regarding the deceased beneficiary. In this way, SSA can reclaim funds which were erroneously paid. The respondents are Canadian financial institutions to which Social Security payments have been made.

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Authorizing Statute(s): US Code: 31 USC 3720 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 30464	05/26/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 43270	07/31/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
SSA-1713/businesses	SSA-1713, SSA-1712, SSA-1712-CN	Statement of Reclamation Action ,   Cover Letter - Statement of Reclamation Action ,   Cover Letter CN - Statement of Reclamation Action
SSA-1713/Not-For-Profit	SSA-1712, SSA-1713, SSA-1712-CN	Cover Letter - Statement of Reclamation Action ,   Statement of Reclamation Action ,   Cover Letter CN - Statement of Reclamation Action

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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	15	0	0	0	0	15
Annual Time Burden (Hours)	1	0	0	0	0	1
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: Form SSA-1713 is currently in use without an OMB number. This information collection, which was inadvertently in use without OMB approval, was discovered in April 2006, and this clearance package was compiled to bring it into compliance with the Paperwork Reduction Act.

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Annual Cost to Federal Government: $23

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 08/22/2006

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