Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody

Forms and Documents

Document Name	Status
Form SSA-781 Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody Form	Modified
Addendum - 0019 (Final).docx Supplementary Document	2022-05-25
Supporting Statement - 0019 (Final).docx Supporting Statement A	2022-05-31

IC Document Collections

IC ID	Document Title	Status
8911	Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody Form	Modified

ICR Details

OMB Control No: 0960-0019	ICR Reference No: 202201-0960-001
Status: Received in OIRA	Previous ICR Reference No: 201810-0960-013
Agency/Subagency: SSA	Agency Tracking No:
Title: Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/31/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2022
Responses	390	14,000
Time Burden (Hours)	228	2,333
Cost Burden (Dollars)	0	0

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Abstract: SSA uses Form SSA-781 to determine if non-custodial parents who file for spouse, mother’s, father’s, or surviving divorced mother’s or father’s benefits based on having a child in their care, meet the “in-care” requirements. The in-care provision requires claimants to have an entitled child under age 16, or disabled in their care. The respondents are applicants for spouse; mother’s; father’s, or surviving divorced mother’s or father’s Social Security 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:
	87 FR 13783	03/10/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 31598	05/24/2022
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
Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody	SSA-781	Certificate of Responsibility for Welfare Care of a Child Not in Applican'ts Custody

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ICR Summary of Burden

	Total Request	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	390	14,000	0	0	-13,610	0
Annual Time Burden (Hours)	228	2,333	0	0	-2,105	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: When we last cleared this IC in 2019, the burden was 2,333 hours. However, we are currently reporting a burden of 33 hours. This change stems from a decrease in the number of responses from 14,000 to 390. In addition, we have decreased the completion time of the form from 10 minutes to 5 minutes. In previous clearances, we had no means in place to track or furnish definitive figures. However, we are now able to track Management Information (MI) data for this collection. Due to this, we have adjusted our number of responses and time burden estimates according to our MI data. Note: The total burden reflected in ROCIS is 228, while the burden cited in #12 of the Supporting Statement is 33. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

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Annual Cost to Federal Government: $55,018

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: 05/31/2022

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