0960-0062 (SSA-24) supporting statement

SUPPORTING STATEMENT FOR FORM SSA-24

APPLICATION FOR SURVIVOR’S BENEFITS

20 CFR 404.611(a) and (c)

OMB No. 0960-0062

A. Justification

1. Surviving family members of deceased armed services personnel can file for benefits at the Social Security Administration (SSA) or the Veterans Administration (VA) to be considered for benefits by both agencies. If applicants go to the VA first, as part of the application process they complete form SSA-24, the Application for Survivors’ Benefits; the VA then forwards form SSA-24 to SSA for processing. If applicants previously filed for SSA benefits at the Agency, SSA simply disregards this form. The respondents are survivors of deceased armed services personnel who are applying for benefits at the VA.

Section 202(o) of the Social Security Act authorizes the Agency to collect information for armed services personnel survivors for benefits determination purposes. Sections 20 CFR 404.611(a) and (c) of the Code of Federal Regulations discuss general Social Security benefits application rules. Section 38 U.S.C. 5105 provides for a joint SSA-VA application for survivors of deceased armed services personnel.

2. When surviving family members of armed services personnel apply at the VA for joint benefits, they are given VA Form 21-534 (attached to this ICR but cleared by the VA) together with form SSA-24 (OMB No. 0960-0062) to complete. The VA sends form SSA-24 to SSA. If the respondents had not previously applied at SSA, the Agency uses the information from form SSA-24 to determine the survivors’ benefits.

3. A PDF copy of this form is available on the VA’s website. However, SSA did not develop an electronic version of the form that could be submitted online under the Agency’s Government Paperwork Elimination Act plan due to the form’s low volume of usage.

4. The nature of the information SSA is collecting and the manner in which we are collecting it preclude duplication. The Agency does not use any other collection instrument to gather data similar to that collected here.

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

6. If SSA did not use this form, we would not have an instrument for a joint VA-SSA application, which would violate the regulatory provisions cited in Question #1. Because we only collect the information once, we cannot collect it 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 inconsistent with 5 CFR 1320.8(d).

8. SSA published the 60-day Advance Federal Register Notice for this collection on March 28, 2008, at 73 FR 16734, and we did not receive any public comments. We published the 30-day Federal Register Notice on May 28, 2008, at 73 FR 30656. If we receive any public comments in response to this Notice, we will forward them to OMB.

We did not consult with outside members of the public in the development or maintenance of this form.

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

10. We protect and hold confidential the information we are requesting 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. The information collection does not contain any questions of a sensitive nature.

12. An estimated 3,200 respondents take 15 minutes each to complete this form each year. The total burden of 800 hours is reflected as burden hours, and we have not calculated a separate cost burden.

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

14. The annual cost to the Federal Government for this collection is approximately $4,298. This estimate represents the costs for printing and distributing the collection instrument and processing the information once the VA sends it to us.

15. There are no changes to the public reporting burden.

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, we avoid Government waste 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

We do not use statistical methods for this information collection.

0960-0062 (SSA-24) supporting statement

2/4/2021

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