Baseline Survey Materials

(SSA Letterhead)

Date

Dear __________:

The Social Security Administration (SSA) is sponsoring a new research study called the Accelerated Benefits (AB) Demonstration. AB will provide health benefits to people who have recently been approved to receive Social Security Disability Insurance (SSDI). The purpose of this research study is to see if people are helped by getting health care benefits before they are eligible for Medicare.

The study is being conducted by two research organizations, MDRC and Mathematica Policy Research, Inc. (MPR). An interviewer from MPR will call you in a few days to conduct a short telephone interview with you. The interview is to see if you are eligible for AB.

You are not required to do the interview. If you decide that you do not want to be interviewed, your Social Security benefits will not be affected by that decision. We would like to encourage you to complete the interview, however, as you might be eligible for health care benefits. The research study will help SSA learn how they can help people with disabilities get better health care.

The information we collect in the survey is completely confidential. It will be used for research purposes only. Your name will never be used in any reports. All of the people working on this study are trained to protect your privacy and must sign a privacy pledge.

Thank you very much for taking the time to consider our request. An information sheet about the project is enclosed. If you have any questions about the survey, please call MPR toll free at xxx-xxx-xxxx. For questions about the demonstration, please call SSA CONTACT at xxx-xxx-xxxx.

Sincerely,

SSA Official

ON REVERSE SIDE OF THIS LETTER

Privacy Act Statement -- The Privacy Act requires us to notify you that we are authorized to collect this information by section 702 of the Social Security Act. You do not have to provide the information requested. However, the information you provide will allow the Social Security Administration (SSA) to better foster independence and community participation among persons with disabilities. The person(s) completing the interview will remain anonymous.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. The OMB control number for this study is 0960-0526. We estimate that it will take about 40 minutes to participate in this activity. Send only comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401.

DRAFT /home/ec2-user/sec/disk/omb/icr/200803-0960-021/doc/6412901 2 02/04/21 6:02 PM