Request for Waiver of Overpayment Recovery or Change in Repayment Rate

Forms and Documents

Document Name	Status
Form SSA-632-BK SSA-632 - Request for Waiver of Overpayment Recovery Form	Unchanged
Form SSA-632-BK SSA-632 - Request for Waiver of Overpayment Recovery Form	Unchanged
Form SSA-634 SSA-634 - Request for Change in Repayment Notice Form	Modified
Form SSA-634 SSA-634 - Request for Change in Repayment Notice Form	Modified
Justification for Non-Substantive Changes - 0037.docx Justification for No Material/Nonsubstantive Change	2023-11-22
Justification for Non-Substantive Changes - 0037.docx Justification for No Material/Nonsubstantive Change	2023-11-22
Supporting Statement - 0037 (Final).docx Supporting Statement A	2023-09-12
Supporting Statement - 0037 (Final).docx Supporting Statement A	2023-09-12

IC Document Collections

IC ID	Document Title	Status
8941	SSA-632 - Request for Waiver of Overpayment Recovery Form	Unchanged
8941	SSA-632 - Request for Waiver of Overpayment Recovery Form	Unchanged
180027	SSA-634 - Request for Change in Repayment Notice Form	Modified
180027	SSA-634 - Request for Change in Repayment Notice Form	Modified

ICR Details

OMB Control No: 0960-0037	ICR Reference No: 202310-0960-004
Status: Active	Previous ICR Reference No: 202106-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Waiver of Overpayment Recovery or Change in Repayment Rate
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/30/2023
	Date Received in OIRA: 11/22/2023
Terms of Clearance: Previous terms of clearance remain in effect.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2024	09/30/2024	09/30/2024
Responses	500,000	0	500,000
Time Burden (Hours)	475,000	0	475,000
Cost Burden (Dollars)	0	0	0

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Abstract: An overpayment occurs when we pay a beneficiary or recipient more benefits than they are due for a given period. When the individual receives the overpaid benefits, they are responsible for repaying the debt. The information collected on the SSA-632 BK is mandatory for SSA to determine if we can waive an overpayment that is $1,000 or more. To determine if an overpaid individual has the ability to repay the overpayment, respondents are required to provide authorization for SSA to obtain their financial account information. A legal guardian must sign the financial authorization for an adult who is legally incompetent or if the overpaid individual is a child. In addition, respondents must provide household expenses, the income for the entire household, and the assets for all dependent household members. The respondent may complete this form alone or with help. The information collected on the SSA-634 is mandatory for SSA to approve a negotiated monthly rate of withholding that would not permit recovery of the overpayment within 36 months. SSA employees will collect this information one-time. An overpaid individual completes and submits this form along with proofs of their income, assets, and expenses. The individual may complete this form alone or with help. SSA is removing the signature requirement, consistent with Executive Order 14058. Respondents are overpaid individuals who are requesting a waiver of recovery of an overpayment, or a lesser rate of withholding. We are submitting this Change Request to remove the signature requirement on the form.

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Authorizing Statute(s): US Code: 42 USC 404 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 1395pp 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:
	86 FR 46897	08/20/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 59262	10/26/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
SSA-632 - Request for Waiver of Overpayment Recovery	SSA-632-BK	Request to Waiver of Overpayment Recovery
SSA-634 - Request for Change in Repayment Notice	SSA-634	Request for Change in Repayment Notice

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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	500,000	500,000	0	0	0	0
Annual Time Burden (Hours)	475,000	475,000	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: $8,195,840

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? 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: 11/22/2023

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