Addendum to the Supporting Statement 0960-0229

Addendum to the Supporting Statement for

Form SSA-8000-BK

Application for Supplemental Security Income

20 CFR, 416.207 & 416.305- 335, Subpart C

OMB No. 0960-0229

Revisions to the Collection Instrument

We removed the collection instrument “February 2009 Brief Survey of Title XVI Applicants.” SSA conducted a survey in 2009 to obtain an estimate of how often people file for disability payments at the request/suggestion of an organization or company. SSA conducted a brief, two-week survey of Title XVI disability applicants. This activity resulted in a one-time addition to the burden.

Other Revisions to the Collection Instrument

Change 1: Questions #2, 3, and 4, page 1: We moved the mailing address (question 1), residence address (question 2), and the direct deposit information (question 3) questions to the top of the application near the identity question.

Justification 1: We moved these questions to coincide with the location of these questions on the Modernized Supplemental Security Income Claims System (MISSICS) application.

Change 2: Question #4, page 1: We revised the direct deposit question, and added a check block “Enroll in Direct Express.” The old version of the question was:

FOR OFFICIAL USE ONLY	DIRECT DEPOSIT PAYMENT ADDRESS (FINANCIAL INSTITUTION)
	Routing Transit Number	C/S Number	Depositor Account	No Account
				Direct Deposit Refused

The new version of the question is:

DIRECT DEPOSIT PAYMENT ADDRESS (FINANCIAL INSTITUTION)
Routing Transit Number	Account Number	Checking Savings	Enroll in Direct Express
			Direct Deposit Refused

Justification 2: To improve clarity and reduce re-contacting the claimant.

Change 3: Question #20, page 5: We added “or homeless” to the “Transient” category for the living arrangements question.

Justification 3: We are making this block consistent with SSA program instructions.

Change 4: Question #30(c), page 8: We added a blank line in the “NO” section to allow space to write the name of the person with home ownership.

Justification 4: We inadvertently excluded this in the previous edition of the form.

Change 5: Question #40(a), page 10: We reworded the question from:

Do you own or does your name appear on, either alone or with other people, the title of any vehicles (auto, truck, motorcycle, camper, boat, etc.)?

to:

Do you own, or does your name appear (alone or with any other person’s name) on the title of any vehicles (auto, truck, motorcycle camper, boat, etc.)?

Justification 5: We reworded the question to improve clarity.

Change 6: Question #50 (a), page 16: We added foreign pension as a type of income.

Justification 6: Consistent with SSA internal instructions.

Change 7: Question #45(a) and (b), page 13: We reworded the parts of this question from:

1. Do you have any land, houses, buildings, real property, property in a foreign country, equipment, mineral rights, items in a safe deposit box, assets set aside for emergencies or for your heirs, or any other property of any kind that has not been shown anywhere else on the application?

2. Describe the property (including size, location, and how it used. If not used now, when was it last used and what is next planned use.).

to:

1. Do you own, or does your name appear (alone or with any other person’s name) on any land, houses, buildings real property, property in a foreign country, equipment, mineral rights, items in a safe deposit box, assets set aside for emergencies or heirs, or any other property of any kind that has not been shown anywhere else on the application?

2. Describe the property (including size, location, and how it is used). If the property is not used now, when was it last used? Do you plan to use the property in the future?

Justification 7: We reworded the question for consistency and clarity purposes.

Change 8: Question #57, page 19: We added “(d.)” beside “Name of School”

Justification 8: We inadvertently left out of the previous edition.

Change 9: Question #64, page 21: We updated the special notice options (SNO) statement.

The old version had the following options:

If you are blind or visually impaired, check the type of mail you want to receive from us.

Certified Regular Regular with a Follow-up phone call

The new version shows the following options:

Standard notice First-Class Standard notice First-Class with a follow-up phone call Standard notice & data CD by First-Class

Standard notice Certified Standard & Braille notices by First-Class Standard & large print notices Standard notice & audio CD

Justification 9: Changed as directed per the class action court case, American Council of the Blind v. Astrue.

Change 10: We updated the title for the Privacy Act and Paperwork Reduction Act statement section on page 22.

Justification 10: On all of the other paper application, the title shows both the Privacy Act and the Paperwork Reduction Act statement.

Change 11: We added space between the Privacy Act statement and the Paperwork Reduction Act statements on page 22.

Justification 11: We added space to make it easier to determine where the Privacy Act statement ends and the Paperwork Reduction Act statement begins.

Change 12: In the “Changes to Report” section on page 23, we updated the “Income” section heading(3^rd bullet). The old version was:

INCOME-You must report to Social Security if you, your spouse/your parent(s):

The new version is:

INCOME-You must report to Social Security if you, your spouse/your parent(s)/other children living in your household

Justification 12: To include more individuals that need to report.

Change 15: In the “Changes to Report” section on page 23, we updated the section regarding parent reporting (7^th bullet). The old version was:

IF YOU ARE UNDER AGE 18 AND YOU ARE LIVING WITH YOUR PARENTS-A report to Social Security must be

made if:

• Your parents have a change in income, a change in their marriage, a change in the value of anything they

own, or either has a change in residence.

The new version is:

IF YOU ARE THE PARENT, STEP PARENT, OR REPRESENTATIVE PAYEE FOR A CHILD UNDER AGE 18-A report to Social Security must be made if:

• There is a change in any income the child, his or her parent(s), step parent, or brother(s) or sister(s) receive.

• There is a change in his or her parents’ or step parent’s marriage, a change in the value of anything they own, or a change in their residence.

• There is a change in the student status of the child’s brother(s) or sister(s).

Justification 15: To include the requirement to report income and student status changes(s) for ineligible children living in the household who are included in the deeming computation.

• We will start using the new version immediately after OMB approval.

• We will destroy stocks of the old version.