Supporting Statement 0444 revised

SUPPORTING STATEMENT FOR FORM SSA-8001-BK

APPLICATION FOR SUPPLEMENTAL SECURITY INCOME

20 CFR 416.305-416.335, Subpart C

OMB No. 0960-0444

A. Justification

1. Section 1631(e)(1) of the Social Security Act (the Act) requires the Commissioner of Social Security to promulgate regulations concerning applications for Supplemental Security Income (SSI) benefits. Section 20 CFR, 416.305-416-.335 of the Code of Federal Regulations provides that the collection of information requested for SSI benefits be on a prescribed form.

2. The Social Security Administration (SSA) uses the information gathered on Form SSA‑8001 to determine applicant’s eligibility for SSI, and the amount of SSI benefits. SSA employees secure this information during interviews conducted with members of the public who wish to file for SSI benefits. SSA uses this form for two purposes, to formally deny SSI benefits for non-medical reasons when information provided by the applicant results in ineligibility or to establish a disability claim but defer the complete development of non-medical issues until the disability is approved. The respondent’s are applicants for SSI benefits.

3. SSA uses online computer technology via the Modernized Supplemental Security Income Claims System (MSSICS) to document information obtained from the claimant and to provide application output for the claimant's signature. Applications taken through MSSICS do not ask questions that are not relevant to the applicant. We believe that using MSSICS improves accuracy in recording responses, results in fewer re-contacts to clarify an applicant's response, and reduces overall interviewing time. However, SSA will continue to secure information with the paper application form for approximately two percent of the claims in case of a temporary computer failure and because MSSICS has some limitations in its use.

4. Form SSA-8001-BK (OMB No. 0960-0444) and Form SSA-8000-BK, Application for Supplemental Security Income (OMB No. 0960-0229) both collect this type of information. However, the respondent only has to complete one form. Therefore, respondents only have to provide the information once.

5. This collection does not significantly affect a substantial number of small businesses or

other small entities.

6. When the claimant expresses an interest in filing for SSI benefits, the respondent must supply the information. If the claimant is unable to file at that time, there is a potential loss of SSI eligibility and, in some States, Medicaid benefits. In addition, any delay in securing the information would result in a delay in determining eligibility and in making the initial payment if the claimant is eligible. Since SSI is a program based on need, delays of this nature are contrary to the intent of the program. There are no technical or legal obstacles that prevent burden reduction.

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

8. The 60-day advance Federal Register Notice published on December 11, 2008, at 73 FR 75488, and SSA received no public comments. The second Notice published on February 17, 2009, at 74 FR 7506. There have been no outside consultations with members of the public

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

10. The information requested on this form is protected and held confidential 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. The information on Form SSA-8001-BK will be collected from approximately 967,531

respondents annually. Of this total, 98% of the claimants will file using MSSICS, and 2% will use the paper forms. In addition, SSA expects that one quarter of the MSSICS respondents will use Signature Proxy. The total burden represents burden hours, and SSA did not calculate a separate cost burden. The below chart shows the breakdown:

Form Type	Number of Respondents	# of Minutes to Complete Form	Burden Hours
MSSIC	711,135	15	177,784
MSSIC/Signature Proxy	237,045	14	55,311
Paper	19,351	18	5,805
Totals:	967,531		238,900

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

14. The annual cost to the Federal Government for the paper application form is approximately $149,002. This estimate is a projection of costs for printing and distributing the form and for collecting the information.

15. There has been a decrease in the number of respondents and burden hours because more individuals are using Form SSA-8000-BK (full application). There is a small program decrease attributed to the completion of the short-term survey.

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

17. OMB exempted SSA from the requirement to print the OMB approval expiration date on its program 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). SSA granted this exemption so the agency would not have to discontinue using otherwise useable editions of forms with outdated expiration dates. In addition, SSA avoids Government waste, because we will not have to destroy and reprint stocks of forms.

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

SSA is not using statistical methods for this collection.