Application for a Social Security Card

Forms and Documents

Document Name	Status
Form SS-5 Application for a Social Security Card Form and Instruction	Modified
0960-0066 Change request documents (revised).docx Justification for No Material/Nonsubstantive Change	2011-07-06

IC Document Collections

IC ID	Document Title	Status
9002	Application for a Social Security Card Form and Instruction	Modified
198351	Authorization to the Social Security Administration to Obtain Personal Information Other-Follow-up Cover Letter	New
198350	Authorization to the Social Security Administration to Obtain Personal Information Other-Cover Letter	New

ICR Details

OMB Control No: 0960-0066	ICR Reference No: 201106-0960-010
Status: Historical Active	Previous ICR Reference No: 201104-0960-011
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for a Social Security Card
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/18/2011
	Date Received in OIRA: 07/08/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2012	05/31/2012	05/31/2012
Responses	13,585,000	0	13,584,000
Time Burden (Hours)	1,933,250	0	1,933,000
Cost Burden (Dollars)	8,367,000	0	8,367,000

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Abstract: Individuals complete forms SS-5 (domestic residents) and SS-5-FS (U.S. nationals living abroad) to request a new or replacement Social Security Number card. In this ICR, we are making the following revisions: 1) We are making several minor changes to the forms SS-5, SS-5FS, 2)We are adding form SSA-2935-OP1(Authorization to the Social Security Administration to Obtain Personal Information)and adding the SSA-93808 as a cover letter to request eveidence. 3)We are adding the SSA-3910, which is cleared under OMB 0960-0707, Medicare Subsidy Quality Review Case Analysis; we are revising the cover letter to include the applicant contact. The SSA-9310 serves as a follow-up to the SSA-9308 Request for Information requesting evidence and the signed form SSA-2935-OP1 (Authorization to the Social Security Administration to Obtain Personal Information) from the applicant/parent/guardian/custodian of record.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
  

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 11185	02/29/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 8607	02/25/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Authorization to the Social Security Administration to Obtain Personal Information	SSA-2935-OP1	Authorization to the Social Security Administration to OBtain Personal Information
Authorization to the Social Security Administration to Obtain Personal Information	SSA-2935-OP1	Authorization to the Social Security Administration to Obtain Personal Information
Application for a Social Security Card	SS-5, SS-5-FS	Application for a Social Security Card ,   Application for a Social Security Card (Foreign Service)

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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	13,585,000	13,584,000	0	1,000	0	0
Annual Time Burden (Hours)	1,933,250	1,933,000	0	250	0	0
Annual Cost Burden (Dollars)	8,367,000	8,367,000	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: No

Burden Reduction Due to:

Short Statement: There has been an increase in burden hours, because we are adding forms SSA-9308 and SSA-9310 to the collection.

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Annual Cost to Federal Government: $62,832,000

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]? 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? 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: 07/08/2011

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