Application for Lump-Sum Death Payment; 404.390 - .392

Forms and Documents

Document Name	Status
Signature Proxy 83c Justifications 07-17-06-- FINAL.doc Justification for No Material/Nonsubstantive Change	2006-08-31

IC Document Collections

IC ID	Document Title	Status
8890	Application for Lump-Sum Death Payment Paper Application / SSA-8	Modified
44962	Application for Lump-Sum Death Payment / Modernized Claims System (MCS)	New
44961	Application for Lump-Sum Death Payment /MCS/ Signature Proxy Application	New

ICR Details

OMB Control No: 0960-0013	ICR Reference No: 200608-0960-019
Status: Historical Active	Previous ICR Reference No: 200401-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Lump-Sum Death Payment; 404.390 - .392
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: 09/15/2006
	Date Received in OIRA: 09/01/2006
Terms of Clearance: OMB approves this burden reduction due to SSA's implementation of the Signature Proxy initiative.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2007	03/31/2007	03/31/2007
Responses	877,000	0	877,000
Time Burden (Hours)	139,223	0	146,167
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected is required to authorize payment of the lump-sum death benefit to a widow, widower, or children as defined in Section 202(i) of the Social Security Act. The respondents are widows, widowers or children who apply for a lump-sum death payment.

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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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Application for Lump-Sum Death Payment / Modernized Claims System (MCS)
Application for Lump-Sum Death Payment /MCS/ Signature Proxy Application
Application for Lump-Sum Death Payment Paper Application / SSA-8

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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	877,000	877,000	0	0	0	0
Annual Time Burden (Hours)	139,223	146,167	0	-6,944	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The Application for Lump-Sum Death Payment is one of the collections cited under our ICB burden reduction Initiative Signature Proxy. The Signature Proxy Initiative is an alternative to the traditional pen and ink or “wet” signature, and it eliminates the need to retain paper applications in most circumstances by allowing the technician to process the application on the claimant’s behalf, without a signature. In most instances, Signature Proxy allows SSA to store and process the entire benefit application electronically, thus reducing costs associated with mailing and storing physical files. In addition, the adoption of Signature Proxy supports faster processing of claims and will improve service to the public by eliminating the need to mail the application to the claimant and wait for it to be signed and returned. Please see the attached Supplementary Documentation which outlines the burden savings achieved through this collection and all other application in the Signature Proxy Initiative.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 09/01/2006

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