Justification for the Non-Substantive Changes to 0960-0160 (Signature Removal)

Justification for Non-Substantive Changes for Form SSA-3885

Government Pension Questionnaire

20 CFR 404.408a

OMB No. 0960-0160

Background

The Social Security Administration (SSA) uses SSA uses the SSA-3885 to: (1) determine whether the Government Pension Offset provision applies; (2) identify exceptions as stated in section 20 CFR 404.408a of the Code of Federal Regulations; and (3) determine the benefit reduction amount and effective date based on the pension information the respondent provides on the form. Currently, the paper and PDF versions of this form requires the respondent completing the form to provide a signature.

SSA recently reassessed the need for the respondent’s signature on this form and determined that we no longer require it. Therefore, we are removing the signature requirement from this form.

Revision to the Information Collection

• Change #1: SSA is removing the signature requirement from Form SSA-3885, as well as the signature block.

Justification #1: We reassessed the need for a wet signature on this form and determined we no longer require it. Therefore, we will no longer ask respondents to sign this form prior to submitting it to SSA.

• Change #2:  We are replacing the Penalty of Perjury Statement with a Penalty of Perjury Warning:

Anyone who knowingly makes or causes to be made a false statement or representation of material fact for use in determining a payment under the Social Security Act, or knowingly conceals or fails to disclose an event with an intent to affect an initial or continued right to payment, or submits or causes to be submitted any false statement or document knowing the same to contain any misrepresentation of material fact, commits a crime punishable under Federal law by fine, imprisonment, or both, and may be subject to administrative sanctions.

• Justification #2:  We are replacing the Penalty of Perjury Statement as it was directly connected to the signature and needs to be removed since we no longer require (or request) a signature on this form. However, to maintain the intent of that statement, we are replacing it with a Penalty of Perjury Warning.

After OMB approves the signature removal for this form, we will implement the new version of the form that clarifies that we no longer require a signature by replacing the signature prompt with one that collects the respondent’s name. This action will not affect the public reporting burden.