SSI Notice of Interim Assistance Reimbursement (IAR)

Forms and Documents

Document Name	Status
g) eIAR Process Form	New
Form SSA-L8125-F6 f) Paper Form SSA-L8125-F6 Form and Instruction	New
Form SSA-8125 e) Paper Form SSA-8125 Form	New
Supporting Statement--0546 (F).doc Supporting Statement A	2008-12-19
IAR State Handbook.pdf Supplementary Document	2008-12-11
Sample MOU Used with States--Final Language.pdf Supplementary Document	2008-11-24
Addendum--0546.doc Supplementary Document	2008-12-19

IC Document Collections

IC ID	Document Title	Status
9467	a) State Notification of Receipt of Authorization (Electronic Process)	Modified
186519	o) Correct Administrative and Accounting Discrepancies	New
186518	n) Participate in Periodic Review	New
186517	m) Retrieve and Consolidate Authorization and Accounting Forms	New
186516	l) Written Notice from State to Recipient Regarding Amount of Payment	New
186515	k) Maintenance of Accounting Forms and Notices	New
186514	j) Maintenance of Authorization Forms	New
186513	i) Review/Signing Agreements	New
186512	h) State Notification to SSA of Deceased Claimant	New
186511	g) eIAR Process Form	New
186510	f) Paper Form SSA-L8125-F6 Form and Instruction	New
186509	e) Paper Form SSA-8125 Form	New
186508	d) State Request for Determination--Dispute Resolution	New
186507	c) State Notification to SSA of Amount of Reimbursement	New
186506	b) State Submission of Copy of Authorization (Manual Process)	New

ICR Details

OMB Control No: 0960-0546	ICR Reference No: 200809-0960-008
Status: Historical Active	Previous ICR Reference No: 200511-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: SSI Notice of Interim Assistance Reimbursement (IAR)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/07/2009
	Date Received in OIRA: 12/19/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2012	36 Months From Approved	02/28/2009
Responses	511,825	0	100,000
Time Burden (Hours)	46,363	0	16,666
Cost Burden (Dollars)	0	0	0

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Abstract: Forms SSA-8125 and SSA-L8125-F6 are used by SSA to obtain the amount of Interim Assistance Reimbursement (IAR) a State is due. When SSA releases the first retroactive SSI payment the SSA-8125 is filled out by the State for accounting and auditing purposes. The SSA-L8125-F6 is used in cases when SSA must ensure that an IAR State does not send a residual IAR payment to a recipient who may be affected by the dedicated account and installment provision as set forth in P.L. 100-203. Respondents are State IAR officers.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 55585	09/25/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 75488	12/11/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

IC Title	Form No.	Form Name
f) Paper Form SSA-L8125-F6	SSA-L8125-F6	Supplemental Security Income Notice of Interim Assistance Reimbursement
i) Review/Signing Agreements
c) State Notification to SSA of Amount of Reimbursement
d) State Request for Determination--Dispute Resolution
e) Paper Form SSA-8125	SSA-8125	Supplemental Security Income Notice of Interim Assistance Reimbursement
h) State Notification to SSA of Deceased Claimant
o) Correct Administrative and Accounting Discrepancies
j) Maintenance of Authorization Forms
n) Participate in Periodic Review
k) Maintenance of Accounting Forms and Notices
g) eIAR Process	N/A	eIAR Internet Screens
a) State Notification of Receipt of Authorization (Electronic Process)
b) State Submission of Copy of Authorization (Manual Process)
l) Written Notice from State to Recipient Regarding Amount of Payment
m) Retrieve and Consolidate Authorization and Accounting Forms

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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	511,825	100,000	0	411,825	0	0
Annual Time Burden (Hours)	46,363	16,666	0	29,697	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: Changing Regulations

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The changes in the public reporting burden are due to several factors. Previously we cleared the burden information for only the SSA-8125 and SSA-L8125-F6; however, we inadvertently did not report the burden information for the business process. Therefore, we are now adding the business process to the clearance package to rectify the potential PRA violation. We are also adding a new eIAR process that will initially increase the overall public reporting burden. There is no burden change for the forms SSA-8125 and SSA-L8125-F6. However, ROCIS shows changes to due adjustments whenever we create ICs for the first time. The only change in burden is a program increase due to the addition of the business process and eIAR burdens.

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Annual Cost to Federal Government: $160,055

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 12/19/2008

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