Questionnaire About Special Veterans Benefits

Forms and Documents

Document Name	Status
Form SSA-2010-F6 Statement for Determining Continuing Entitlement for Special Veternans Benefits (SVB) Form	Modified
Addendum - 0782.docx Supplementary Document	2016-06-24
Supporting Statement 0782 (revised).doc Supporting Statement A	2016-08-17

IC Document Collections

IC ID	Document Title	Status
189024	Statement for Determining Continuing Entitlement for Special Veternans Benefits (SVB) Form	Modified

ICR Details

OMB Control No: 0960-0782	ICR Reference No: 201604-0960-005
Status: Historical Active	Previous ICR Reference No: 201303-0960-010
Agency/Subagency: SSA	Agency Tracking No:
Title: Questionnaire About Special Veterans Benefits
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/23/2016
	Date Received in OIRA: 06/24/2016
Terms of Clearance: This collection is approved based on the revised materials provided by the Agency.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	08/31/2016
Responses	1,799	0	1,308
Time Burden (Hours)	600	0	436
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA uses the information collected on the SSA-2010 to determine continuing eligibility for Special Veterans Benefits and to determine how much (if any) of a foreign pension may be used to reduce or increase the amount of Social Security retirement Special Veterans Benefits. Depending on their age, respondents complete the SSA-2010 every year or every other year so that SSA can determine if benefits may be increased, decreased, suspended, or terminated, based on the data collected. The respondents are beneficiaries receiving Social Security Special Veterans Benefits.

---

Authorizing Statute(s): US Code: 42 USC 403 Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
  

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:
	81 FR 22697	04/18/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 39990	06/20/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Statement for Determining Continuing Entitlement for Special Veternans Benefits (SVB)	SSA-2010-F6	Questionnaire About Special Veterans Benefits

---

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	1,799	1,308	0	0	491	0
Annual Time Burden (Hours)	600	436	0	0	164	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The increase in burden hours stems from increase in the number of eligible respondents using Form SSA-2010.

---

Annual Cost to Federal Government: $10,371

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]? 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: 06/24/2016

---