Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records

ICR 201810-0960-017

OMB: 0960-0293

Federal Form Document

Forms and Documents
ICR Details
0960-0293 201810-0960-017
Active 201602-0960-001
SSA
Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records
Revision of a currently approved collection   No
Regular
Approved without change 06/25/2019
Retrieve Notice of Action (NOA) 02/04/2019
In accordance with 5 CFR 1320, the information collection is approved for three years.
  Inventory as of this Action Requested Previously Approved
06/30/2022 36 Months From Approved 06/30/2019
16,000,000 0 16,000,000
542,667 0 550,167
0 0 0

SSA collects and verifies financial account information from individuals requesting a waiver of their Title II and Title XVI overpayments, as well as those who apply for, or currently receive (in the case of redetermination) Supplemental Security Income (SSI) payments. We require financial information from these individual’s to: (1) determine the eligibility of the applicant or recipient for SSI benefits; or (2) determine if a request to waive a Social Security overpayment defeats the purpose of the Act. If an individual provides incomplete or seemingly altered records, or if records are unavailable, SSA contacts his or her financial institutions to verify the existence; ownership; and value of accounts owned. Financial institutions need individuals to sign Form SSA-4641-F4, or contact SSA and use the Internet version, e4641, to authorize them to disclose the individual’s records to SSA. The respondents are Title II and Title XVI recipients applying for waivers, or SSI applicants, recipients, and their deemors to determine SSI eligibility.

US Code: 42 USC 1383 Name of Law: Social Security Act
   PL: Pub.L. 114 - 74 834 Name of Law: Bipartisan Budget Act
   US Code: 12 USC 35, sections 3402-3404 Name of Law: Right to Financial Privacy Act of 1978
  
None

Not associated with rulemaking

  83 FR 56133 11/09/2018
84 FR 371 01/25/2019
No

  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 16,000,000 16,000,000 0 0 0 0
Annual Time Burden (Hours) 542,667 550,167 0 0 -7,500 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
When we last cleared this IC in 2015, the burden was 550,167 hours. However, we are currently reporting a burden of 542,667 hours. This change stems from a decrease in the number of responses for the SSA-4641 from 252,500 to 140,000, and an increase in the number of responses for the e4641 from 15,747,500 to 15,860,000. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change.

$13,800,013
No
    Yes
    Yes
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.
02/04/2019


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