Addendum to Supporting Statement

Addendum to the Supporting Statement for Form SSA-788,

Statement of Care and Responsibility for Beneficiary

20 CFR 404.2020, 404.2025, 408.620, 408.625, 416.620, 416.625

OMB No. 0960-0109

Terms of Clearance:

TERMS OF CLEARANCE:

Approved consistent with memo dated 8/11/06

Memo dated 8/11/06:

OMB has the following comments on "Statement of Care and Responsibility for Beneficiary":

• The supporting statement indicates that Form SSA-788 is available online in a PDF format to be filled out and mailed to SSA.  Is this correct?  It appears that SSA prefills in the top half of the first page with information on the benie and the applicant.  If SSA didn't prefill this information, how would a respondent obtain the information? 

The form SSA-788 was established on the Internet in PDF format for easy access by SSA, and is not intended for use by the public.  SSA is responsible for completing and mailing the form to the custodian of the beneficiary where the payee applicant does not have custody of the beneficiary.  SSA is responsible for completing the top-portion, the information would not be available to the custodian.      

 

OMB Response: Please update item 3 of the supporting statement to reflect this and send a copy to OMB; the current language states that respondents can fill out, print and send the form to SSA via the online PDF.  This question is intended to elicit information on the agency's use of electronic technology to collect the information from respondents, not how the agency manages the distribution of the forms internally. 

SSA’s Response: Please see the attached Supporting Statement in which #3 has been revised.

• Item 6 (p. 2) does not include alternate forms of contact (e.g., phone calls, emails).  Suggest revising the "writes letters" to something like "calls/ writes/ emails."  

Not many representative payees or facilities have the capacity to do accept emails.  For this reason, we do not believe email is an effective source of an alternate way to contact the representative payees.    

 

OMB Response: Does SSA never accept emails as an appropriate form of contact because of this?  Even though some rep payees may not have the capacity to accept emails, others may.  Also, your response does not address the issue of phone calls.  Does SSA agree to add phone contact to this form? 

 

SSA’s Response:  The point of this question is to determine if the custodian is aware of the contact between the payee and the beneficiary.  In most facilities, visits and letters are monitored.  However, telephone calls are generally made directly to and from a beneficiary's room and are not monitored.  Therefore, we do not think we should add “phone contact” to the form.  In regards to adding “email contact” as an option, at the present time, we believe that very few, if any, beneficiaries in custodial facilities use email, and any such email correspondence is probably not monitored by facilities.  Therefore, due to the way in which the care facilities manage the correspondence of these beneficiaries, at the present time we see no need to add an email contact option.

• Since these forms are currently filled in by hand, it does not appear that there is enough space on Item 7 (p. 2) to fill in both the full address and the phone number.  

For our purposes, either an address or telephone number can be used in this block.       

 

OMB Response:  In that case, shouldn't the form state "Address or Phone No." rather than "Address/ Phone No."?    

 

SSA’s Response: The "Remarks" section allows room for any information that may be curtailed because of spacing issues.  However, we have decided that as per your original comment, we will expand the block for “Address/Phone No.” to increase the available space at the next scheduled reprint.

In response to the Terms of Clearance stated above, SSA has done the following:

1. Revised #3 of the Supporting Statement to indicate that the SSA-788 cannot be made electronic at this time, as it is an SSA-generated form which contains pre-filled information that is specific to the intended respondent.

2. As per the above response, SSA will not be changing the SSA-788 to include “email contact” at this time as most facilities do not monitor email or phone calls to the beneficiaries.

3. SSA expanded the block for “Address/Phone No.” for the reprint subsequent to the above memo dated 8/10/06.

We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.

We are also revising the Privacy Act statement to ensure that it is accurate and complete.