STATE AND LOCAL GOVERNMENT AGENCIES
SUBMIT THE SSA-1610-U2 TO THE SOCI SECURITY ADMINISTRATION (SSA) TO
REQUEST INFORMATION CONCERNING SOCIAL SECURITY
BENEFICIARIES/RECIPIENTS WHO HAVE APPLIED FOR PUBLIC ASSISTAN FROM
A STATE OR LOCAL GOVERNMENT AGENCY. THE IDENTIFYING INFORMATION
SUBMITTED TO SSA ON THE FORM IS USED TO SEARCH FOR AND RETRIEVE
APPROPRIATE DATA. THE DATA IS ENTERED ON THE FORM AND THE FORM
RETURN
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:
(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;
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.