Supporting Statement--0001 revised

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. Introduction/Authoring Laws and Regulations

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 a deceased worker at specific times, and the parent is required to file proof of such support within specified times. This requirement is in accordance with 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. The form SSA-760-F4, Certificate of Support, is the collection instrument for this information.

2. Description of Collection

The Social Security Administration (SSA) uses 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. The respondents will complete the form on their own or as part of an interview with an SSA employee. The respondents are individuals who are parents of deceased workers, or spouses who may meet the exception to the Government Pension Offset.

3. Use of Information Technology to Collect the Information

SSA did not create an electronic version of form SSA-760-F4 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 18,000 respondents complete the form. This is less than the GPEA cut-off of 50,000.

4. Why We Cannot Use Duplicate Information

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 obtain similar data.

5. Minimizing Burden on Small Respondents

This collection does not affect small businesses or other small entities.

6. Consequence of Not Collecting Information or Collecting it Less Frequently

If SSA did not collect the information, we would not be able 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. Since SSA collects this information on an as-needed basis, we cannot collect it less frequently.

There are no technical or legal obstacles to burden reduction.

7. Special Circumstances

There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.

8. Solicitation of Public Comment and Other Consultations with the Public

SSA published the 60-day advance Federal Register Notice on October 26, 2009 at 74 FR 55080, and we received no public comments. The second Notice published on December 28, 2009 at 74 FR 68655. If we receive comments in response to the 30-day Notice, we will forward them to OMB. We did not consult with the public in the revision/maintenance of this form.

Note: This is a correction notice. SSA published this information collection as an extension on October 26, 2009, at 74 FR 55080. Since we are revising the Privacy Act Statement, this is now a revision of an OMB-approved information collection.

9. Payment or Gifts to Respondents

SSA does not provide payments or gifts to the respondents.

10. Assurances of Confidentiality

SSA protects and holds confidential the information it collects 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. Justification for Sensitive Questions

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

12. Estimates of Public Reporting Burden

Approximately 18,000 respondents take 15 minutes each to complete form SSA-760-F4 each year. Accordingly, the burden is 4,500 burden hours. This figure represents burden hours, and we did not calculate a separate cost burden

13. Annual Cost to the Respondents (Other)

This collection does not impose a known cost burden on the respondents.

14. Annual Cost To Federal Government

The annual cost to the Federal Government for this collection 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. Program Changes or Adjustments to the Information Collection Request

There are no changes to the public reporting burden.

16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

17. Displaying the OMB Approval Expiration Date

OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.

18. Exceptions to Certification Statement

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

SSA does not use statistical methods for this information collection.

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