Supporting Statement 0960-0012

Supporting Statement for Form SSA-7-F6,

Application for Parent’s Insurance Benefits

20 CFR 404.370, 20 CFR 404.371, 20 CFR 404.373, 20 CFR 404.374 and

20 CFR 404.601 404.603

OMB No. 0960-0012

1. Justification

1. Introduction/Authoring Laws and Regulations

Section 202(h) of the Social Security Act provides the eligibility conditions a claimant must meet to receive monthly benefits as a parent of a deceased worker.

Sections 20 CFR 404.370, 404.371, 404.373, 404.374 and 404.601-404.603 of the Code of Federal Regulations prescribe the eligibility criteria and application instructions for these benefits.

2. Description of Collection

The Social Security Administration (SSA) uses Form SSA-7-F6, Application for Parent’s Insurance Benefits, to obtain the information necessary to determine whether respondents, who are claimants for monthly benefits as parents of a deceased worker, meet the eligibility and application criteria. The respondents are applicants and recipients of Social Security Old Age, Survivors, and Disability Insurance benefits.

3. Use of Information Technology to Collect the Information

Form SSA-7-F6 is available in PDF format on SSA’s website for respondents to print and mail back to SSA. SSA also collects the information electronically during a personal or telephone interview using SSA’s Modernized Claims System (MCS).

In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Intranet version of Form SSA-7-F6.

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 we did not use Form SSA-7-F6, the public would have no way to apply for parent benefits. Because we only collect the information once, we cannot collect it less frequently.

There are no technical or legal obstacles to prevent 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 March 9, 2015, at 80 FR 12542, and we received no public comments. We published the 30-day FRN published on May 27, 2015 at 80 FR 30316. If we receive any comments in response to this Notice, we will forward them to OMB.

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 1 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

Modality of Completion	Number of Respondents	Frequency of Response	Average Burden per Response (minutes)	Estimated Total Annual Burden (hours)
MCS	153	1	15	38
MCS/Signature Proxy*	158	1	14	37
Paper	4	1	15	1
Totals	315			76

The total annual burden for this information collection request is 76 hours. This figure represents burden hours, and we did not calculate a separate cost burden.

*Under the Signature Proxy process, respondents give their “signature” by verbal consent for telephone claims or by clicking a button for Internet claims. Signature Proxy is an alternative to the traditional pen and ink or “wet” signature, and it eliminates the need to retain paper applications in most circumstances by allowing the technician to process the application on the claimant’s behalf, without a signature. In most instances, Signature Proxy allows SSA to store and process the entire application electronically, thus reducing costs associated with mailing and storing physical files. In addition, the adoption of Signature Proxy supports faster processing of claims and improves service to the public by eliminating the need to mail the form to the claimant and wait for them to sign and return it.

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

There are no changes to the public reporting burden. The annual cost to the Federal Government is approximately $1,455. This estimate is a projection of the costs for printing and distributing the collection instrument.

15. Program Changes or Adjustments to the Information Collection Request

There are no changes to the public reporting burden.

16. Program Changes or Adjustments to the Information Collection Request

SSA will not publish the results of the information collection.

17. Plans for Publication Information Collection Results

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. Displaying the OMB Approval Expiration Date

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. Collection of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.