Application to Collect A Fee for Payee Services

Forms and Documents

Document Name	Status
Form SSA-445 Application to Collect A Fee for Payee Services Form	Modified
Form SSA-445 Applicaiton To Collect A Fee For Payee Services Form	New
Supporting Statement 0960-0719.doc Supporting Statement A	2009-02-12
Addendum 0719.doc Supplementary Document	2009-02-09

IC Document Collections

IC ID	Document Title	Status
9776	Application to Collect A Fee for Payee Services Form	Modified
188037	Applicaiton To Collect A Fee For Payee Services Form	New

ICR Details

OMB Control No: 0960-0719	ICR Reference No: 200809-0960-006
Status: Historical Active	Previous ICR Reference No: 200512-0960-011
Agency/Subagency: SSA	Agency Tracking No:
Title: Application to Collect A Fee for Payee Services
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: 04/24/2009
	Date Received in OIRA: 02/13/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2012	36 Months From Approved	04/30/2009
Responses	100	0	100
Time Burden (Hours)	17	0	17
Cost Burden (Dollars)	0	0	0

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Abstract: The Social Security Administration uses information it collects on Form SSA-445 to determine whether to authorize or deny permission to collect fees for payee services. The respondents are private sector businesses or State and local government offices applying to become a fee-for-service organizational representative payee.

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Authorizing Statute(s): US Code: 42 USC 405 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:
	73 FR 53919	09/17/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 2644	01/15/2009
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
Application to Collect A Fee for Payee Services	SSA-445	Application to Collect a Fee for Payee Services (State/local government)
Applicaiton To Collect A Fee For Payee Services	SSA-445	Application To Collect A Fee For Payee Services (Private Sector)

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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	100	100	0	0	0	0
Annual Time Burden (Hours)	17	17	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Before ROCIS, we were not able to separate the information collections. ROCIS shows a change in the burden due to the separation of IC's however, there is no increase/decrease in the burden.

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Annual Cost to Federal Government: $600

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? Yes

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)? No

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: 02/13/2009

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