Statement Regarding The Inferred Death of an Individual By Reason of Continued and Unexplained Absence

Forms and Documents

Document Name	Status
Form SSA-723 Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexplained Absence Form	New
Supporting Statement - SSA-723.docx Supporting Statement A	2020-02-26
Supporting Statement - SSA-723.docx Supporting Statement A	2020-02-26

IC Document Collections

IC ID	Document Title	Status
238986	SSA-723 - Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexplained Absence Form	New	Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexplained Absence
238986	SSA-723 - Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexplained Absence Other-PRA Statement	New

ICR Details

OMB Control No: 0960-0844	ICR Reference No: 201909-0960-005
Status: Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement Regarding The Inferred Death of an Individual By Reason of Continued and Unexplained Absence
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/19/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/28/2020
Terms of Clearance: In accordance with 5 CFR 1320, this information collection is approved.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	36 Months From Approved
Responses	3,000	0	0
Time Burden (Hours)	1,500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Before SSA can declare a missing individual deceased, we must ensure there is no evidence indicating the individual is still alive. SSA uses Form SSA-723, the Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexpected Absence, to collect the information needed to make that determination. In cases where insured wage earners have been absent from their homes for at least seven years, and there is no evidence these individuals are alive, SSA may presume they are deceased and will pay their survivors the appropriate benefits. SSA uses the information from Form SSA-723 to determine if we may presume a missing wage earner is deceased, and, if so, to establish a date of presumed death. The respondents are relatives, friends, neighbors, or acquaintances of the presumed deceased wage earner, or the person who is filing for survivor’s benefits.

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Authorizing Statute(s): US Code: 42 USC 402 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:
	84 FR 66262	12/03/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 10804	02/25/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
SSA-723 - Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexplained Absence	SSA-723	Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexplained Absence

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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	3,000	0	0	3,000	0	0
Annual Time Burden (Hours)	1,500	0	0	1,500	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: No

Burden Reduction Due to:

Short Statement: This is a new form that increases the public reporting burden.

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Annual Cost to Federal Government: $5,000

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

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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: 02/28/2020

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