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	Modified
Addendum - 0037.doc Supplementary Document	2011-01-06
Supporting Statement 0037 (revised).doc Supporting Statement A	2011-03-28

IC Document Collections

IC ID	Document Title	Status
8941	Request for Waiver of Overpayment Recovery Form	Modified
195878	Internet Instructions Instruction	New
195877	Regional Application (NY Debt Management-NYDM) Other-MSSICS Screen	New
180027	Request for Change in Repayment Notice Form	Modified

ICR Details

OMB Control No: 0960-0037	ICR Reference No: 201011-0960-011
Status: Historical Active	Previous ICR Reference No: 200812-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Waiver of Overpayment Recovery or Change in Repayment Rate
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/18/2011
	Date Received in OIRA: 03/31/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2014	36 Months From Approved	08/31/2011
Responses	1,044,000	0	500,000
Time Burden (Hours)	1,004,667	0	916,666
Cost Burden (Dollars)	0	0	0

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Abstract: The overpaid individual uses the SSA–632–BK to request a waiver of recovery of an overpayment. The individual explains why they feel they are without fault in causing the overpayment and provides financial information, so SSA can determine whether recovery would cause financial hardship. If the individual agrees to repay the overpayment, they can use the SSA–632–BK to inform SSA they want to repay at a monthly rate that would take more than thirty-six months to recover the overpayment. The individual can also use the SSA–632–BK to request a different rate of recovery. In those cases, they must provide financial information to SSA for a determination of how much the overpaid person can afford to repay each month. Respondents are overpaid beneficiaries or claimants who are requesting a waiver of recovery of the overpayment, or a lesser rate of withholding.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 1395pp Name of Law: Social Security Act
   US Code: 42 USC 404 Name of Law: Social Security Act
  

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:
	76 FR 205	01/03/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 16847	03/25/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Request for Waiver of Overpayment Recovery	SSA-632-BK	Request to Waiver of Overpayment Recovery
Request for Change in Repayment Notice	SSA-632-BK	Request for Waiver of Overpayment Recovery or Change in Repayment Notice
Regional Application (NY Debt Management-NYDM)	SSA-632-BK	Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate
Internet Instructions

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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	1,044,000	500,000	0	544,000	0	0
Annual Time Burden (Hours)	1,004,667	916,666	0	121,334	-33,333	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: There has been a decrease to the burden hours for form SSA-632-BK, due to fewer respondents submitting request for Waiver of Overpayment Recovery. There has been a decrease in burden hours for the Change in Repayment request, due to fewer respondents requesting payment changes. There has been an increase in burden hours due to some Regional intranet applications (not nationwide) printing and mailing IC to respondents. This added an additional 44,000 respondents to the total. There been an increase in burden hours due to adding internet instructions to the collection.

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Annual Cost to Federal Government: $3,337,935

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 03/31/2011

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