Supporting Statement for Form SSA-760-F4
Certificate Of Support
20 CFR 404.408a, 404.370, and 404.750
OMB No. 0960-0001
A. Justification
Introduction/Authoring Laws and Regulations
Section 202(h) of the Social Security Act (Act) gives the requirements for entitlement to parent’s Social Security benefits. Parents must have received at least one-half of their support from a deceased worker at specific times, and we require the parents to file proof of such support within specified times. This requirement is in accordance with 20 CFR 404.370 and 20 CFR 404.750 of the Code of Federal Regulations. The one-half support requirement also applies in determining if a spouse applicant is subject to the Government Pension Offset (GPO). This requirement is set forth in 20 CFR 404.408a.
Description of Collection
A parent of a deceased, fully insured worker may be entitled to Social Security Old‑Age, Survivors, and Disability Insurance (OASDI) benefits based on the earnings record of the deceased worker under certain conditions. One of the conditions is the parent must have received at least one-half support from the deceased worker. The one-half support requirement also applies to a spousal applicant in determining whether OASDI benefits are subject to GPO. SSA uses the information from Form SSA-760-F4 to determine if the parent of a deceased worker or a spouse applicant meets the one-half support requirement. Respondents are (1) parents of deceased workers and (2) spouses who may meet the GPO exception.
Use of Information Technology to Collect the Information
SSA did not create an electronic version of Form SSA-760-F4 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 18,000 respondents complete the form. This is less than the GPEA cut-off of 50,000.
Why We Cannot Use Duplicate Information
The nature of the information we are 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 collect the information, we would not be able to determine the one‑half support requirements for two classes of SSA claimants: (1) parents of deceased workers and (2) spouses who may be subject to the GPO. Because we only collect this information on an as-needed basis, we cannot collect it less frequently.
There are no technical or legal obstacles to 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
The 60-day advance Federal Register Notice published on July 29, 2015, at 80 FR 45265, and we received no public comments. SSA published the second Notice on September 25, 2015, at 79 FR 57907. If we receive comments in response to the 30‑day Notice, we will forward them to OMB. We did not consult with the public in the revision of this form.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects 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
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Approximately 18,000 respondents take 15 minutes each to complete form SSA-760-F4 each year. Accordingly, the burden is 4,500 burden hours:
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Total Annual Burden (hours) |
SSA-760-F4 |
18,000 |
1 |
15 |
4,500 |
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 Federal Government
The annual cost to the Federal Government for this collection is approximately $55,440. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
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 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 does not use statistical methods for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | SUPPORTING STATEMENT FOR FORM SSA-760-F4 |
| Author | Faye Lipsky |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |