Supporting Statement--0001

SUPPORTING STATEMENT FOR FORM SSA-760-F4

CERTIFICATE OF SUPPORT

20 CFR 404.408a, 404.370, and 404.750

OMB No. 0960-0001

A. Justification

1. Section 202(h) of the Social Security Act gives the requirements for entitlement to parent’s Social Security benefits. A parent must have received at least one-half of his/her support from the deceased worker at specific times, and the parent is required to file proof of such support within specified times. This requirement is also set forth in 20 CFR 404.370 and 20 CFR 404.750 of the Code of Federal Regulations. The one-half support requirement also applies in determining if a spouse applicant is subject to the Government Pension Offset (GPO). This requirement is set forth in 20 CFR 404.408a.

2. The Social Security Administration (SSA) needs the information collected by form SSA-760-F4 to determine one-half support for entitlement to parent’s benefits and to determine whether the GPO would apply to a spouse applicant. This information is collected at the time an applicant applies for benefits. Respondents are parents of deceased workers, or spouses who may meet exception to Government Pension Offset.

3. Currently, the SSA-760-F4 is not scheduled for electronic implementation due to its low volume of usage. Not other system collects the information obtained from completion of this supplemental form.

4. The nature of the information being collected and the manner in which it is collected preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.

5. This collection of information does not impact small businesses or other small entities.

6. The information is collected in order to determine the one-half support requirements for two classes of SSA claimants: (1) parents of deceased workers and (2) spouses who may be subject to the GPO. Because it is only used when needed, the information cannot be collected less frequently. If the information is not collected, the legal requirement for collecting this information will not be fulfilled, and it will be impossible to determine the true benefits an applicant should receive. There are no technical or legal obstacles that prevent burden reduction.

7. There are no special circumstances that would cause this information collection to be conducted in a manner that is not consistent with 5 CFR 1320.5.

8. The 60-day advance Federal Register Notice was published on December 15, 2006 at 71 FR 75607, and SSA has received no public comments. The second Notice was published on February 14, 2007, at 72 FR 7107. There have been no outside consultations with members of the public.

9. SSA provides no payment or gifts to the respondents.

10. The information requested is protected and held confidential in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.

11. This information collection does not contain any questions of a sensitive nature.

12. Form SSA-760-F4 will be used by approximately 18,000 respondents annually. The estimated average response time is 15 minutes, for a total of 4,500 burden hours. The total burden is reflected as burden hours. No separate cost burden has been calculated.

13. There is no known cost burden to the respondents.

14. The estimated cost to the Federal Government is approximately $55,440. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.

15. There have been no program changes or adjustments in this form, and there are no changes to the public reporting burden.

16. The results of the information collection will not be published.

17. OMB has granted SSA an exemption from the requirement that the expiration date for OMB approval be printed on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). This exemption was granted so that otherwise useable editions of forms would not be taken out of circulation because the expiration date had been reached. In addition, Government waste has been avoided because stocks of forms will not have to be destroyed and reprinted.

18. SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

2. Collections of Information Employing Statistical Methods

Statistical methods are not used for this information collection.

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