Request for Waiver of Overpayment Recovery or Change in Repayment Rate

Forms and Documents

Document Name	Status
Form SSA-632-BK Request for Waiver of Overpayment Recovery Form	Modified
Form SSA-632-BK Request for Change in Repayment Notice Form	New
Addendum--0037.doc Supplementary Document	2007-05-09
Supporting Statement--0037.doc Supporting Statement A	2007-07-02

IC Document Collections

IC ID	Document Title	Status
8941	Request for Waiver of Overpayment Recovery Form	Modified
180027	Request for Change in Repayment Notice Form	New

ICR Details

OMB Control No: 0960-0037	ICR Reference No: 200705-0960-003
Status: Historical Active	Previous ICR Reference No: 200406-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Waiver of Overpayment Recovery or Change in Repayment Rate
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/04/2007
	Date Received in OIRA: 07/03/2007
Terms of Clearance: This ICR is approved for 18 months only because the explanation for not providing an electronic version of the form is not satisfactory. Given the large number of respondents who use this form, the ability to submit these forms electronically should be a priority, on a par similar to other forms SSA has made available electronically due to the volume of their use. Upon resubmission of this form for OMB approval, SSA will either make this form electronically available or provide a detailed justification of why the agency was not able to make the form electronically available. The justification should go well beyond simply asserting that it is not an agency priority and include a timeframe when SSA expects the form will become available electronically. If privacy is a concern, SSA should explain in detail why the information collected on this form is more sensitive than other forms which SSA offers electronically. SSA should also include a description of the available technology to safeguard electronic transmission of data and why these are inadequate.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2009	36 Months From Approved	08/31/2007
Responses	500,000	0	500,000
Time Burden (Hours)	875,000	0	875,000
Cost Burden (Dollars)	0	0	0

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Abstract: The SSA-632-BK is used by a beneficiary/claimant to request a waiver of recovery of an overpayment by explaining why they feel they are without fault in causing the overpayment and to provide financial circumstances so that SSA can determine whether recovery would cause financial hardship. It is also used to request a different rate of recovery. In those cases the financial information must be provided for SSA to determine how much the overpaid person can afford to repay each month. Respondents are overpaid beneficiaries or claimants who are requesting a waiver of recovery for overpayment or a lesser rate of withholding.

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Authorizing Statute(s): US Code: 42 USC 404 Name of Law: null
   US Code: 42 USC 1383 Name of Law: null
   US Code: 42 USC 1395pp 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:
	72 FR 14845	03/29/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 35293	06/27/2007
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
Request for Waiver of Overpayment Recovery	SSA-632-BK	Request for Waiver of Overpayment Recovery or Change in Repayment Notice
Request for Change in Repayment Notice	SSA-632-BK	Request for Waiver of Overpayment Recovery or Change in Repayment Notice

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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	500,000	500,000	0	0	0	0
Annual Time Burden (Hours)	875,000	875,000	0	0	0	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: There is no change in the burden data for this ICR or in the usage of this form. However, because in ROCIS we are unable to accurately portray the breakdown of the burden between the two uses of the form in one IC (as we did in the past before ROCIS), SSA has split the burden data between two ICs.

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Annual Cost to Federal Government: $3,080,000

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]? 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)? Uncollected

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: 07/03/2007

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