Supporting Statement--0004(F)

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Supporting Statement for Form SSA-10-BK,

Application for Widow’s or Widower’s Insurance Benefits

20 CFR 404.335 – 404.338; 20 CFR 404.603

OMB NO. 0960-0004

1. Justification

1. Section 202(e) and 202(f) of the Social Security Act (the Act) set forth the requirements for entitlement to widow(er)’s benefits, including the requirement to file an application. The policies for implementing the requirements in sections 202(e) and 202(f) of the Act, including the requirement to apply for benefits, are set forth in 20 CFR 404.335 – 404.338 of the Code of Federal Regulations. In order to become entitled to benefits, 20 CFR 404.603 requires that an application be filed. Form SSA-10-BK is the collection instrument designated by the Commissioner of Social Security to meet the application requirement.

2. The Social Security Administration (SSA) uses the information collected on Form SSA-10-BK to determine whether the applicant meets the statutory and regulatory condition for entitlement to widow(er)’s benefits. The respondents are applicants for widow or widower’s benefits.

3. The information collected on the paper Form SSA-10-BK is also collected electronically, during a personal interview, using SSA’s Modernized Claims System (MCS). These are agency-initiated forms with pre-filled information. Approximately 95 percent of the data collection in claims for widow(er)’s benefits is electronic. Additional information technology, which would further reduce the burden, is not available at this time.

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 does not have a significant impact on a substantial number of small businesses or other small entities.

6. If this information were not collected, SSA would not be able to determine whether the applicant meets the statutory and regulatory requirements for entitlement without the data collected on Form SSA-10-BK. The Social Security Act and regulations prescribe when an application is required; therefore, SSA cannot collect this information less frequently. 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 June 13, 2006 at 71 FR 34180, and SSA has received no public comments. The second Notice was published on September 18, 2006, at 71 FR 54705. 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. The information collection does not contain any questions of a sensitive nature.

12. Approximately 341,560 respondents will use the paper/electronic Form SSA-10-BK annually. Of this total 95% (324,482) are completed through the Modernized Claims System (MCS) and 50% of the MCS respondents will use Signature Proxy (162,241). Using Signature Proxy reduces the burden by 1 minute per respondent. Shown below is the breakdown:

Collection Method	Number of Respondents	Estimated Completion time	Burden Hours
MCS	162,241	15 minutes	40,560
MCS/Signature Proxy	162,241	14 minutes	37,856
Paper	17,078	15 minutes	4,270
Totals:	341,560		82,686

The total burden is reflected as burden hours, and no separate cost burden has been calculated.

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

14. The annual cost to the Federal Government is approximately $2,104,010. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.

15. The increase in the public reporting burden is due to an increase in the number of respondents for the widow(er)’s benefits.

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.