Non-Substantive Change 0960-0103

Justification for Non-Substantive Changes for Form SSA-7163A

SUPPLEMENTAL STATEMENT REGARDING FARMING ACTIVITIES OF PERSON LIVING OUTSIDE THE U.S.A.

20 CFR 404.401(b)(l), 404.415 and 404.417

OMB No. 0960-0103

Background

The Social Security Administration (SSA) uses Form SSA-7163A, Supplemental Statement Regarding Farming Activities of Person Living Outside the U.S.A., to determine if we should apply foreign work deductions to the Title II benefits of a beneficiary who is living on a farm or is a farmer outside the United States. Currently, the paper and PDF versions of this form includes a signature requirement.

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-7163A.

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: On page 1, we are removing “Be sure to sign this statement.”

Justification #2: This instruction is not needed because the form will no longer require a wet signature.

• Change #3:  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 #3:  The Penalty of Perjury Statement is directly connected to the signature and needs to be removed since a signature is no longer required. However, to maintain the intent of that statement, it will be replaced with a Penalty of Perjury

Warning.

• Change #4: On page 5, we are changing “SIGNATURE OF PERSON COMPLETING THIS STATEMENT” to “NAME OF PERSON COMPLETING THIS STATEMENT”.

Justification #4: While we will no longer require a wet signature, we still need to know who is making the report.

• Change #5: On page 5, we are removing the fields that require two witnesses to sign and provide their address.

Justification #5: These fields are not needed since the form will no longer require a wet signature.

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 removing the signature block.

This action will not affect the public reporting burden.