Supporting Statement--0037

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Supporting Statement for SSA-632-BK

Request for Waiver of Overpayment

Recovery or Change in Repayment Notice

20 CFR 404.502-.513, 404.515 and 20 CFR 416.550-.570, 416.572

OMB No. 0960-0037

A. Justification

1. Sections 204, 1631(b) and 1879 of the Social Security Act (the Act) require the Social Security Administration (SSA) to recover overpayments of Federal Retirement, Survivors, Disability Insurance, Health Insurance Benefits or Supplemental Security Income Payments made to a recipient, unless recovery of the overpayment may be waived. Recovery of an overpayment may be waived only if: (1) the person is not at fault in causing the overpayment; and (2) recovery would deprive that person of income necessary to meet his/her ordinary living expenses or would otherwise be unfair. The policies for implementing the pertinent sections of the Act are set forth in 20 CFR 404.502-404.513, 404.515 and 20 CFR 416.550-416.570, 416.572 of the Code of Federal Regulations.

2. Form SSA-632-BK obtains the information necessary to determine whether the provisions of the Act regarding waiver of recovery of the overpayment are met. The information on the form is needed to determine a repayment rate if repayment cannot be waived. Respondents are overpaid beneficiaries or claimants who are requesting a waiver of recovery for overpayment or a lesser rate of withholding.

3. Improved information technology that would reduce the burden is not available as this form contains sensitive information. Until more secure methods exist to safeguard the respondents’ personal information, we cannot make this form available electronically. Overpaid beneficiaries have the option to call SSA in order to protest or request a change in repayment at which time an SSA representative will send a copy of the SSA-632-BK with the parts of the form irrelevant to their case crossed out, and the parts that they will need to fill out highlighted.

4. The nature of the information being collected and the manner in which it is collected preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.

5. This information collection does not impact small businesses or other small entities.

6. The collection must take place based upon the need of the applicant. If the information is not collected, waiver may be precluded and the overpayment would be recovered incorrectly. Therefore, incorrect payments to beneficiaries could result if the information were collected less frequently. There are no technical or legal obstacles that prevent burden reduction.

7. There are no special circumstances that would cause this information collection to be conducted in a manner that is not consistent with 5 CFR 1320.5.

8. The 60-day advance Federal Register Notice was published on March 29, 2007 at 72 FR 14845, and SSA has received no public comments. The second Notice was published on June 27, 2007, at 72 FR 35293. There have been no outside consultations with members of the public.

9. SSA provides no payment or gifts to the respondents.

10. The information requested on this form is protected and held confidential in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.

11. This information collection does not contain any questions of a sensitive nature.

12. Form SSA-632-BK will be used by approximately 500,000 respondents annually. The estimated average response time is 2 hours for the 400,000 respondents who are requesting a waiver of overpayment, yielding a total of 800,000 burden hours; and 45 minutes for 100,000 respondents who are requesting a change in repayment and therefore only need to complete page one and part II questions of the form (financial information), yielding a total of 75,000 burden hours. The total burden hours for this collection are 875,000. The below chart shows these distinctions:

Type of Request	Number of Respondents	Frequency of Response	Average Burden per Response	Total Annual Burden
Waiver of Overpayment (Completes Whole Form)	400,000	1	2 hours	800,000
Change in Repayment (Completes Partial Form)	100,000	1	45 minutes	75,000
Totals	500,000			875,000

The total burden is reflected as burden hours, and no separate cost burden has been calculated.

13. There is no known cost burden to the respondents.

14. The annual cost to the Federal Government is approximately $3,080,000. This estimate is a projection of printing and distribution costs for the information collection.

15. 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.

16. The results of the information collection will not be published.

17. OMB has granted SSA an exemption from the requirement that the expiration date for OMB approval be printed on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). This exemption was granted so that otherwise useable editions of forms would not be taken out of circulation because the expiration date had been reached. In addition, Government waste has been avoided because stocks of forms will not have to be destroyed and reprinted.

18. SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

B. Collections of Information Employing Statistical Methods

Statistical methods are not used for this information collection.