Application for Search of Census Records for Proof of Age

ICR 201110-0960-004

OMB: 0960-0097

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2012-01-19
Supporting Statement A
2012-01-19
IC Document Collections
ICR Details
0960-0097 201110-0960-004
Historical Active 200812-0960-016
SSA
Application for Search of Census Records for Proof of Age
Revision of a currently approved collection   No
Regular
Approved without change 02/26/2012
Retrieve Notice of Action (NOA) 01/26/2012
  Inventory as of this Action Requested Previously Approved
02/28/2015 36 Months From Approved 05/31/2012
18,030 0 18,030
3,606 0 3,606
0 0 0

SSA collects information on the SSA-1535-U3 to provide the Census Bureau with sufficient identification information, allowing an accurate search of census records to establish proof of age for an individual applying for Social Security benefits. When preferred evidence of age is not available or the available evidence is not convincing, SSA may request the U.S. Department of Commerce, Bureau of the Census, to search its records to establish a claimant's date of birth. The Census Bureau uses a completed, signed SSA-1535-U3 to bill SSA for the search. The respondents are applicants for Social Security benefits who need to establish their date of birth as a factor of entitlement.

US Code: 42 USC 405 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  76 FR 68806 11/07/2011
77 FR 2114 01/13/2012
No

1
IC Title Form No. Form Name
Application for Search of Census Records for Proof of Age SSA-1535-U3 Application for Search of Census Records for Proof of Age

  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 18,030 18,030 0 0 0 0
Annual Time Burden (Hours) 3,606 3,606 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$700
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/26/2012


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