THE INFORMATION COLLECTED BY THIS FORM
IS USED BY THE SOCIAL SECURITY ADMINISTRATION (SSA) TO DETERMINE IF
THE BENEFIT OF A RECIPIENT OF SUPPLEMENTAL SECURITY INCOME (SSI)
PAYMENTS SHOULD BE MODIFIED OR DISCOUNTINUED BASED ON THE CHANGE
REPORTED. THE AFFECTED PUBLIC CONSISTS OF SSI RECIPIENTS WHO USE
THIS FORM TO REPORT CHANGES TO SSA.
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:
(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;
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.