Supporting Statement for Form SSA-445
Application to Collect a Fee for Payee Services
20 CFR 404.2040, 416.640
Justification
1. The Social Security Administration (SSA) can authorize certain organizational representative payees to collect a fee for providing payee services. Before an organization may collect a fee for payee services, a Form SSA-445, Application to Collect a Fee for Payee Services, must be completed and submitted to the local Social Security office. The form organizes the collection of information, serves as a standard collection instrument, and allows SSA and the organization to keep all information in one place for future reference. SSA uses Form SSA-445 as a reference for consultative purposes at the time of payee review or audit. The collection of information in this form is authorized under Section 205.1631(j)(4)(A)(I) of the Social Security Act (the Act) and
20 CFR 404.2040, 404.640 of the Code of Federal Regulations.
2. Information on the form provided by the applicant is solely for SSA use. SSA will use the information to assess whether the applicant meets the requirements to become a fee-for-service organizational payee and whether the applicant has provided all of the information and documentation required for SSA to make this determination. Based on the information provided on the form, SSA will issue a determination authorizing or denying the applicant permission to collect fees for payee services. The form is available in paper form and as a downloadable PDF file. The respondents are private sector businesses or State and local government offices applying to become a fee-for-service organizational representative payee.
3. Form SSA-445 will not be converted to an electronic form since the estimated number of submissions of the form has an annual volume of less than 100. SSA has determined it is not cost effective, nor does it justify the creation of a separate internet web-based collection site for these purposes.
4. The nature of the information SSA is collecting and the manner in which we are collecting it preclude duplication. There is no other collection
instrument used by SSA that collects data similar to that collected here.
5. This collection does not have a significant impact on a substantial number of small businesses or other small entities.
6. 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. SSA published the 60-day Federal Register notice on September 17, 2008 at 73 FR 53919. SSA published the 30-day notice on January 15, 2009 at 74 FR 2644. 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 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. The information collection does not contain any questions of a sensitive nature.
Approximately 100 respondents use Form SSA-445 annually. The respondents are private sector businesses and State/local government offices. No individual/households or Federal Government entities may respond. The private sector businesses are not-for-profit organizations and make up 90 percent of the respondents annually; the remaining 10 percent are State/local government offices. The estimated response time is 10 minutes, for a total of 17 burden hours.
|
Number of Respondents |
Frequency of Response |
Average burden Per Response (minutes) |
Burden Hours |
Private Sector Business |
90 |
1 |
10 |
15 |
State/local government offices |
10 |
1 |
10 |
2 |
Totals |
100 |
1 |
|
17 |
The total burden represents burden hours, and SSA did not calculate a separate cost burden.
13. There is no known cost burden to the respondents.
14. The annual cost to the Federal Government is approximately $600. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
There are no changes in the public reporting burden. However, prior to ROCIS we were not able to separate the information collections. Since we can now separate the information collections, ROCIS shows a change in burden, but there has been no change in burden.
16. SSA will not publish the results of the information collected.
17. OMB exempted SSA from publishing the expiration date for OMB
approval on its 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). OMB granted this exemption so that SSA would not have to stop using otherwise useable editions of forms with outdated expiration dates. In addition, SSA avoids Government waste because we do not have to destroy and reprint stocks of forms.
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).
Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT INSTRUCTIONS FOR |
| Author | 243560 |
| Last Modified By | Debbie |
| File Modified | 2009-02-12 |
| File Created | 2009-02-11 |