Data Exchange Request Form

Forms and Documents

Document Name	Status
Form SSA-157 eCBSV Applicants – SSA-157 with Certification Statement Form	New
Form SSA-157 Data Exchange Request Form - State and Local Governments Form	Unchanged
Form SSA-157 Data Exchange Request Form - Private Sector Respondents Form	Unchanged
Justification for Non-Substantive Changes - 0802.docx Justification for No Material/Nonsubstantive Change	2019-05-07

IC Document Collections

IC ID	Document Title	Status
235841	eCBSV Applicants – SSA-157 with Certification Statement Form	New
215703	Data Exchange Request Form - State and Local Governments Form	Unchanged
215635	Data Exchange Request Form - Private Sector Respondents Form	Unchanged

ICR Details

OMB Control No: 0960-0802	ICR Reference No: 201904-0960-014
Status: Active	Previous ICR Reference No: 201803-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Data Exchange Request Form
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/29/2019
	Date Received in OIRA: 05/07/2019
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	12/31/2021	12/31/2021
Responses	346	0	146
Time Burden (Hours)	180	0	73
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA engages in various forms of data exchanges from Social Security number verifications to computer matches for benefit eligibility, depending on the requestor's business needs. Section 1106 of the Social Security Act requires we consider the requestor's legal authority to receive the data, our disclosure policies, systems' feasibility, systems' security, and costs before entering into a data exchange agreement. We will use Form SSA-157, Data Exchange Request Form, for this purpose. Respondents are Federal, State, local, and foreign governments, as well as private organizations seeking to share data electronically with SSA. Before we can develop the new electronic Consent Based Social Security Number (SSN) Verification (eCBSV) service, we need to come up with 50% of the startup costs. To do this, we will roll out the service to a limited number of users in June 2020. We are completing a Non-Substantive Change Request to furnish selected eCBSV entities an instructional example SSA-157 to aid in completion of the form, and a copy of the MOU for the initial rollout.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 17872	04/24/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 31987	07/10/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
eCBSV Applicants – SSA-157 with Certification Statement	SSA-157	Data Exchange Request Form
Data Exchange Request Form - State and Local Governments	SSA-157	Data Exchange Request Form
Data Exchange Request Form - Private Sector Respondents	SSA-157	Data Exchange Request Form

---

ICR Summary of Burden

	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	346	146	0	200	0	0
Annual Time Burden (Hours)	180	73	0	107	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Due to the new eCBSV SSA-157 users, we anticipate an additional 200 respondents for this collection.

---

Annual Cost to Federal Government: $11,533

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/07/2019

---