Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate

Forms and Documents

Document Name	Status
Form SSA-2032-BK Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate Form	Modified
Supporting Statement - 0698.docx Supporting Statement A	2016-12-14
Addendum - 0698.doc Supplementary Document	2016-12-05

IC Document Collections

IC ID	Document Title	Status
9752	Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate Form	Modified

ICR Details

OMB Control No: 0960-0698	ICR Reference No: 201609-0960-013
Status: Historical Active	Previous ICR Reference No: 201607-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Waiver of Special Veterans Benefits (SVB) 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: 03/16/2017
	Date Received in OIRA: 12/14/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved	03/31/2017
Responses	450	0	450
Time Burden (Hours)	900	0	900
Cost Burden (Dollars)	0	0	0

---

Abstract: Title VIII of the Social Security Act allows SSA to pay a monthly benefit to a qualified World War II veteran who resides outside the United States. When an overpayment in SVB occurs, the beneficiary can request a waiver of recovery of the overpayment or a change in the repayment rate. SSA uses the SSA–2032–BK to obtain the information necessary to establish whether the claimant meets the waiver of recovery provisions of the overpayment, and to determine the repayment rate if we do not waive repayment. Respondents are beneficiaries who have overpayments on their Title VIII record and wish to file a claim for waiver of recovery or change in repayment rate. This Non-Substantive Change Request adds a fillable version of the form.

---

Authorizing Statute(s): US Code: 42 USC 1008 Name of Law: The Social Security Act
   PL: Pub.L. 108 - 203 210 Name of Law: The Social Security Protection Act of 2004
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 68091	10/03/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 86374	11/30/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate	SSA-2032-BK	Request for Waiver of special veterans Benefit (SVB) Overpayment Recovery or Change in Repayment

---

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	450	450	0	0	0	0
Annual Time Burden (Hours)	900	900	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $1,242

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

---

Common Form ICR:  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:

(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: 12/14/2016

---