Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation

Forms and Documents

Document Name	Status
Form SSA-770-U4 Notice Regarding Substitution of Party Upon Death of Claimant--Reconsiderationof Disability Cessation Form	Modified
Supporting Statement - 0351.docx Supporting Statement A	2019-02-25
Addendum - 0351.docx Supplementary Document	2019-02-25

IC Document Collections

IC ID	Document Title	Status
9238	Notice Regarding Substitution of Party Upon Death of Claimant--Reconsiderationof Disability Cessation Form	Modified

ICR Details

OMB Control No: 0960-0351	ICR Reference No: 201811-0960-003
Status: Active	Previous ICR Reference No: 201511-0960-017
Agency/Subagency: SSA	Agency Tracking No:
Title: Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation
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: 06/18/2019
	Date Received in OIRA: 03/11/2019
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved	06/30/2019
Responses	1,200	0	1,200
Time Burden (Hours)	100	0	100
Cost Burden (Dollars)	0	0	0

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Abstract: When a claimant dies before we make a determination on their request for reconsideration of a disability cessation, SSA conducts a search through the applicant’s records, on the Master Beneficiary Record (MBR), for a qualified substitute party to pursue the appeal. We search for a widow or widower of the deceased; a surviving divorced spouse; a child; a disabled child; a parent; the administrator or executor of the estate of the deceased; or any person whom we can consider qualified to pursue the appeal. The information we collect on Form SSA-770 is the basis of our decision to continue or discontinue the appeals process. Respondents are substitute applicants who are pursuing a reconsideration request for a deceased claimant.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 62943	12/06/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 4597	02/15/2019
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Notice Regarding Substitution of Party Upon Death of Claimant--Reconsiderationof Disability Cessation	SSA-770-U4	Notice Regarding Substitution of Party Upon Death of Claimant--Reconsideration of Disability Cessation

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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	1,200	1,200	0	0	0	0
Annual Time Burden (Hours)	100	100	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:

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Annual Cost to Federal Government: $1,848

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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

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Common Form ICR:  No

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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: 03/11/2019

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