Private Printing and Modification of Prescribed Application and Other Forms

ICR 201607-0960-012

OMB: 0960-0663

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2016-10-28
IC Document Collections
ICR Details
0960-0663 201607-0960-012
Historical Active 201309-0960-003
SSA
Private Printing and Modification of Prescribed Application and Other Forms
Revision of a currently approved collection   No
Regular
Approved without change 12/12/2016
Retrieve Notice of Action (NOA) 10/28/2016
  Inventory as of this Action Requested Previously Approved
12/31/2019 36 Months From Approved 01/31/2017
150 0 225
25 0 30
0 0 0

Regulation 20 CFR 422.527 states that any person, institution, or organization wishing to privately reproduce, duplicate, or print any of SSA's applications (such as forms) must first obtain written approval from SSA to do so. The respondents are persons or organizations wishing to privately reproduce or print any of SSA's applications.

US Code: 42 USC 1320b¿10 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  81 FR 51957 08/05/2016
81 FR 73189 10/24/2016
No

1
IC Title Form No. Form Name
Private Printing and Modification of Prescribed Application and Other Forms

  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 150 225 0 -75 0 0
Annual Time Burden (Hours) 25 30 0 -5 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The burden decrease is due to fewer companies providing SSA forms to their clients in a way that requires review by SSA, as well as regulations put in place around the time of the previous OMB review becoming standard practice.

$897
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/28/2016


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