Individuals who apply for the Medicare
Part D subsidy must report all of their financial accounts. In
cases where SSA chooses to verify applicants' account balances, we
use Form SSA-4640 to: (1) obtain applicants' authorizations to
contact their financial institutions and (2) verify balances with
the financial institutions. The respondents are applicants for the
Medicare Part D subsidy with financial accounts, and the
institutions where those accounts are held.
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.