Supporting Statement for
SSA-640
Financial Disclosure for Civil Monetary Penalty (CMP)
Debt
20 CFR 498
OMB No. 0960-0776
Justification
Introduction/Authoring
Laws and Regulations
Section
1129
of the
Social Security Act (Act)
governs the imposition
of civil monetary penalties (CMP) and assessments on individuals
for fraudulent conduct related to Social Security
Administration(SSA)-administered programs. This section states the
methods SSA uses to collect the CMP, including benefit withholding
and installment agreements. For SSA to determine a monthly
repayment amount, the agency needs financial information from the
CMP-imposed individual. The policies for implementing Section 1129
of the Act are in 20
CFR 498 of the Code
of Federal Regulations.
Description of Collection
SSA uses Form SSA-640, Financial Disclosure for CMP Debt, to obtain the information we need to determine a monthly installment agreement rate from CMP-imposed individuals. Respondents are individuals under a CMP for fraudulent conduct related to SSA-administered programs, who have not entered into any prior settlement agreement and are not currently receiving benefits.
Use
of Information Technology to Collect the Information
SSA
did not create an electronic version of Form SSA-640 under the
agency’s Government Paperwork Elimination Act (GPEA) plan
because the low number of respondents completing this form is less
than the GPEA cut-off of 50,000.
Why
We Cannot Use Duplicate Information
The
nature of the information SSA is collecting and the manner in which
we are collecting it preclude duplication. SSA does not use
another collection instrument to obtain similar data.
Minimizing
Burden on Small Respondents
This
collection does not affect small businesses or other small
entities.
Consequence
of Not Collecting Information or Collecting it Less Frequently
If
SSA did not conduct this information collection, we would have no
means of allowing imposed individuals to participate in an
installment repayment agreement. Since we only collect the
information when we need to prepare an installment plan, we cannot
collect it less frequently. There are no technical or legal
obstacles to prevent burden reduction.
Special
Circumstances
There
are no special circumstances that would cause SSA to conduct this
information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation
of Public Comment and Other Consultations with the Public
SSA
published the 60-day advance Federal Register Notice on March 30,
2012 at 77 FR 19406, and we received no public comments. We
published the 30-day Federal Register Notice on June 14, 2012, at
77 FR 35739. If we receive any comments from the 30-day Notice, we
will forward them to OMB. We did not consult with the public on
the maintenance of this form.
Payments
or Gifts to Respondents
SSA
does not provide payment or gifts to the respondents.
Assurances
of Confidentiality
SSA
protects and holds confidential the information we collect 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.
Justification
for Sensitive Questions
This
information collection requests personal financial information.
Although an individual’s response is voluntary, failure to
provide all or part of the requested information could prevent SSA
from making an accurate and timely decision regarding a fair and
equitable monthly
payment amount the individual must pay to satisfy the CMP. SSA
keeps all information confidential.
Estimates
of Public Reporting Burden
Approximately
400 respondents take 120 minutes to complete Form SSA-640 each
year. Accordingly, the burden is 800 hours. This figure
represents burden hours and we did not calculate a separate cost
burden.
Annual
Cost to the
Respondents (Other)
This
collection does not impose a known cost burden on the respondents.
Annual
Cost to the Federal Government
The
annual cost to the Federal Government is approximately $4,312.
This estimate is a projection of printing and distribution costs
for the information collection.
Program
Changes or Adjustments to the Information Collection Request
There
are no changes to the public reporting burden.
Plans
for Publication Information Collection Results
SSA
will not publish the results of the information collection.
Displaying
the OMB Approval Expiration Date
OMB
granted SSA an exemption from the requirement to print the OMB
expiration date on its program forms. SSA produces millions of
public-use forms with life cycles exceeding those of an OMB
approval. Since SSA does not periodically revise and reprint its
public-use forms (e.g., on an annual basis), OMB granted this
exemption so SSA would not have to destroy stocks of otherwise
useable forms with expired OMB approval dates, avoiding Government
waste.
Exceptions
to the Certification Statement
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
did not use statistical methods for this information collection.
File Type | application/msword |
Author | 564947 |
Last Modified By | 889123 |
File Modified | 2012-06-18 |
File Created | 2012-03-23 |