Tribal Council Coverage Agreement

Forms and Documents

Document Name	Status
Supporting Statement - 0812 (Final).docx Supporting Statement A	2022-03-22

IC Document Collections

IC ID	Document Title	Status
235112	Tribal Council Coverage Agreement Other-Indian Tribal Council Coverage Agreement	Modified

ICR Details

OMB Control No: 0960-0812	ICR Reference No: 202109-0960-003
Status: Received in OIRA	Previous ICR Reference No: 201911-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Tribal Council Coverage Agreement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/22/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2022
Responses	12	100
Time Burden (Hours)	2	17
Cost Burden (Dollars)	0	0

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Abstract: SSA uses the Tribal Council Coverage Agreement to collect information if a tribe wishes to obtain Social Security coverage. Each tribe requesting coverage fills out an agreement, and SSA employees collect the information via form SSA-177 or SSA-177-OP1. The respondents are Indian tribal councils who wish to receive Social Security coverage for their members.

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Authorizing Statute(s): None

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:
	86 FR 68034	11/30/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 6929	02/07/2022
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
Tribal Council Coverage Agreement

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ICR Summary of Burden

	Total Request	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	12	100	0	0	-88	0
Annual Time Burden (Hours)	2	17	0	0	-15	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: When we last cleared this IC in 2019, it was a new collection. We estimated an original burden of 17 hours. However, we are currently reporting a burden of 2 hours. This change stems from a decrease in the number of responses from 100 to 12. When we first developed this collection, we overestimated its potential use, and are correcting it now. 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. These figures represent current Management Information data.

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Annual Cost to Federal Government: $3,877

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.     No

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.     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? No

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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: 03/22/2022

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