supporting statement 0324

Supporting Statement for Form SSA-L8050-U3

Supplemental Security Income Claim Information Notice

20 CFR, Subpart B, 416.210

OMB No. 0960-0324

A. Justification

1. The authority for the Social Security Administration (SSA) to collect the information requested on Form SSA-L8050-U3 is contained in Section 1611(e)(2), Title XVI of the Social Security Act (the Act), as amended, and in Section 20 CFR, Subpart B, 416.210 of the Code of Federal Regulations. In order to meet the eligibility requirements for supplemental security income (SSI), the statute requires that an individual file for and obtain all payments (annuities, pensions, disability benefits, veteran's compensation, etc.) for which he/she is eligible. The regulations state, in part, that an individual is not eligible for SSI benefits if he/she does not apply for all other benefits for which he/she may be eligible.

2. SSA collects the information in order to identify those SSI claimants/recipients who are potentially eligible for benefits from other sources and to ensure that these individuals file for such benefits. Potential income from other sources must be developed and verified to establish eligibility, since the SSI program is a program of assistance based on need.

3. Due to the high risk of payment error and low volume usage of this form, SSA has not scheduled the SSA-L8050-U3 for electronic implementation in the near future.

4. The nature of the information being collected and the manner in which it is collected preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.

5. Part 3 of this form must be completed by the organization or agency (public or private) from which benefits may be payable. The responding agency or organization is required to check one of five blocks regarding the status of the SSI claimant/recipient and to sign and date the form. A return postage-paid envelope is enclosed for transmittal back to SSA. The information requested from the respondents represents the minimum amount of data required to verify an individual's eligibility for other benefits.

6. Failure of the agency to conduct timely reviews of other potential sources of income and/or benefits could result in overpayments to claimants or recipients; therefore, SSA cannot collect the information less frequently. There are no technical or legal obstacles that prevent burden reduction.

7. There are no special circumstances that would cause SSA to collect the information in a manner that is not consistent with 5 CFR 1320.5.

8. SSA published the 60-day advance January 15, 2009, at 74 FR 2642, and we received no public comments. SSA published the 30-day Federal Register Notice on March 19, 2009, at 74 FR 11804. There have been no outside consultations with members of the public.

9. SSA provides no payment or gifts to the respondents.

10. SSA protects and holds confidential the information in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.

11. The information collection does not contain any questions of a sensitive nature.

12. Approximately 7,500 respondents complete part 3 of the form SSA-L8050-U3 annually. The estimated average response time is 10 minutes, for a total of 1,250 burden hours. The total burden is reflected as burden hours, and no separate cost burden has been calculated.

13. There is no known cost burden to the respondents.

14. The annual cost to the Federal government is approximately $23,100. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.

15. There are no changes in the public reporting burden.

16. SSA will not publish the results of this information collection.

17. OMB exempted SSA from publishing the expiration date for OMB approval on its forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). OMB granted this exemption so that SSA would not have to stop using otherwise useable editions of forms would not be taken out of circulation because the expiration date had been reached. In addition, government waste has been avoided because stocks of forms will not have to be destroyed and reprinted.

18. SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

B. Collections of Information Employing Statistical Methods

Statistical methods are not used for this information collection.