Template - State Court Adult Guardianship Practices Online Survey - ACUS Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0960-0788)

TITLE OF INFORMATION COLLECTION: State Court Adult Guardianship Practices Online Survey

PURPOSE: The Social Security Administration (SSA) provides Old Age, Survivors, and Disability Insurance (OASDI) benefits and Supplemental Security Income (SSI) payments to many of the most vulnerable members of society: the young, the elderly, and people with disabilities. SSA appoints a representative payee after determining that OASDI beneficiaries or SSI recipients are incapable of managing their own benefits. About seven million recipients of OASDI benefits and SSI payments have representative payees—either a person or an organization—to receive or manage their benefits.

SSA has engaged the Administrative Conference of the United States (ACUS) - an independent Federal agency whose mission includes providing nonpartisan expert advice and recommendations for improvement of Federal administrative processes and procedures - to study state court practices relating to the selection, monitoring, and sanctioning of guardians.

The goals of this study are: (1) to explore possibilities for improved sharing of information and coordination between SSA and state courts on overlapping guardianship-representative payee matters; and (2) to identify new, potential sources of representative payees from among existing rosters or lists of approved guardians maintained by state courts.

DESCRIPTION OF RESPONDENTS:

We will direct the survey to a sampling of judges and administrators in each state who work at state courts that handle adult guardianship matters (which are typically, though not exclusively, probate courts), though responses from members of a national guardianship organization will also be solicited.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Faye Lipsky, _Reports Clearance Officer, Social Security Administration

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X ] No

2. If yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No N/A

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (minutes)	Burden (hours)
State Court Officials	600	30	300
Members of a National Guardianship Organization	400	10	67
Totals	1,000		367

FEDERAL COST: The estimated annual cost to the Federal Government is $27,000.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The survey will primarily be directed to a sampling of judges and administrators in each state who work at state courts that handle adult guardianship matters (which are typically, though not exclusively, probate courts), though responses from members of a national guardianship organization will also be solicited.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ X ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

3