Letter to Custodian of Birth Records, 20 CFR 404.704, 404.716, 416.802, and 422.107

Forms and Documents

Document Name	Status
Form SSA-L106 SSA-L106 Letter to Custodian of School Records (Private Sector) Form	Modified
Form SSA-L106 L106, Letter to Custodian of School Records (Local/State/Tribal Government) Form	New
Form SSA-L706 SSA-L706 Letter to Custodian of Birth Records (Private Sector) Form and Instruction	New
Form SSA-L706 SSA-L706 Letter to Custodian of Birth Records (State & Local) Form and Instruction	New
L106_L706_supporting statement (Final).doc Supporting Statement A	2007-11-29
L106_L706_Addendum.doc Supplementary Document	2007-11-28
original L706.pdf Supplementary Document	2007-11-15

IC Document Collections

IC ID	Document Title	Status
9747	SSA-L106 Letter to Custodian of School Records (Private Sector) Form	Modified
182865	L106, Letter to Custodian of School Records (Local/State/Tribal Government) Form	New
182860	SSA-L706 Letter to Custodian of Birth Records (Private Sector) Form and Instruction	New
182859	SSA-L706 Letter to Custodian of Birth Records (State & Local) Form and Instruction	New

ICR Details

OMB Control No: 0960-0693	ICR Reference No: 200711-0960-003
Status: Historical Active	Previous ICR Reference No: 200410-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Letter to Custodian of Birth Records, 20 CFR 404.704, 404.716, 416.802, and 422.107
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: 01/17/2008
	Date Received in OIRA: 11/29/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved	01/31/2008
Responses	7,200	0	7,200
Time Burden (Hours)	1,200	0	1,200
Cost Burden (Dollars)	0	0	0

---

Abstract: The information collected by forms SSA-L106 and SSA-L706 is used by SSA to assist claimants in obtaining evidence necessary to establish age. The respondents are applicants for Social Security payments.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
  

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:
	72 FR 46529	08/20/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 66216	11/27/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
SSA-L706 Letter to Custodian of Birth Records (Private Sector)	SSA-L706	Letter to Custodian of Birth Records
SSA-L106 Letter to Custodian of School Records (Private Sector)	SSA-L106	Letter to Custodian of School Records
SSA-L706 Letter to Custodian of Birth Records (State & Local)	SSA-L706	Letter to Custodian of Birth Records
L106, Letter to Custodian of School Records (Local/State/Tribal Government)	SSA-L106	Letter to Custodian of Birth Records

---

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	7,200	7,200	0	0	0	0
Annual Time Burden (Hours)	1,200	1,200	0	0	0	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: There is no change in the public reporting burden. The burden changes shown in ROCIS are due to the addition of three ICs which was necessary in order to show the burden per type of respondent (Private Sector and State/Local/Tribal Government) per form. Before ROCIS we did not have the ability to split the burden amongst these two types of respondents and, therefore, only reported one burden. Now that we have the ability to show the burden in this way, we have done so in ROCIS.

---

Annual Cost to Federal Government: $22,176

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

---

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: 11/29/2007

---