Supporting Statement for Form SSA-19-F6
Application for Special Age 72-or-Over Monthly Payments
20 CFR 404.380-404.384
OMB # 0960-0096
A. Justification
1. Section 228(a) of the Social Security Act provides for payment of monthly benefits to certain uninsured individuals who attained age 72 before 1972. This section also contains conditions that the beneficiary must meet, including filing an application. 20 CFR 404.380-404.384 explain special benefits and describes who is entitled to these special benefits. These regulations describe Age, effective dates, amounts, and conditions for suspension and nonpayment.
2. The Social Security Administration (SSA) uses the data collected on Form SSA-19-F6 solely to determine whether the applicant and spouse are entitled to special age-72 payments. Respondents are applicants for benefits based on the attainment of age 72 before 1972.
3. Form SSA-19-F6 is available in paper format only. This form is used by a small number of respondents whose numbers decrease on a yearly basis. Because of this fact, it would not be cost effective for SSA to use other methods of information technology to collect the target information.
4. The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to collect similar data.
5. This collection does not significantly affect a substantial number of small businesses or other small entities.
6. Under Federal Statute, SSA must collect this information when individuals become eligible for special age 72 payment. If SSA did not collect this information, we would be in violation of Federal Statute. Therefore, SSA cannot collect the information less frequently. There are no technical or legal obstacles preventing burden reduction.
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
The 60-day advance Federal Register Notice published on January 26, 2009, at 74 FR 4498, and SSA received no public comments. The second Notice published on April 07, 2009, at 74 FR 15808. SSA did not consult members of the public in the development of this form.
SSA provides no payment or gifts to the respondents.
SSA protects and holds confidential the information it is requesting 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.
This information collection does not contain any questions of a sensitive nature.
Approximately 10 respondents use Form SSA-19-F6 annually. The estimated average response time is 10 minutes for a total of 2 burden hours. The total burden represents burden hours, and SSA did not calculate a separate cost burden.
There is no known cost burden to the respondents.
The annual cost to the Federal Government is approximately $46. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
There are no changes in the public reporting burden.
SSA will not publish the results of the information collection.
OMB exempted SSA from the requirement to print the OMB approval expiration date 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). OMB granted this exemption so the agency would not have to discontinue using otherwise useable editions of forms with outdated expiration dates. In addition, SSA avoids Government waste, because we will not have to destroy and reprint stocks of forms.
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).
B. Collections of Information Employing Statistical Methods
SSA is not using statistical methods for this collection.
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| File Type | application/msword |
| File Title | June 2000 |
| Author | Nancina Thompson |
| Last Modified By | Mandley, Tasha |
| File Modified | 2009-04-08 |
| File Created | 2008-12-29 |