Addendum to Supporting Statement

Addendum to the Supporting Statement for Form SSA-827

Authorization to Disclose Information to the Social Security Administration (SSA)

20 CFR Subpart P, 404.1512 and Subpart I, 416.912

OMB No. 0960-0623

Creating a Different Modality of the Collection Instrument

SSA intends to implement a new electronic authorization process (eAuthorization) for the SSA‑827 that will greatly reduce the need for disability claimants to return the wet signed form through the mail. Acquiring a wet signature on this form can often take weeks, causing unnecessary delays in processing claims for one of the most vulnerable segments of our population.

Since 2004, SSA adopted alternative signature methods to the traditional pen and ink signature in order to implement a fully electronic application process. These signature alternatives, or “signature proxies,” include a “click and sign” option and attestation.

While we already implemented an electronic process for our disability application and other forms, the SSA-827 is the last vestige of paper in the electronic disability application process. We receive disability claims via three methods: face-to-face, telephone, and internet. During the face-to-face interview, we provide claimants with a paper SSA-827 to review and wet sign. We currently mail the SSA-827 to claimants who choose the telephone interview. Internet filers may download a PDF of the paper form. Claimants filing by telephone or the internet must sign, date and return the form to SSA. In all three scenarios, the SSA claims representative (CR) faxes the wet signed form into the electronic disability folder.

The “click and sign” method for an electronic signature is useful for internet claims, but not face-to-face and telephone interviews. For those applications, SSA currently uses an electronic signature method that includes a verbal attestation process.

We propose to extend our electronic signature process to include the SSA-827. When obtaining the SSA-827 during the face-to-face and telephone interview, the CR will ask the claimant if they have read the form and will answer any of the claimant’s questions. The CR will use scripted language to:

• explain that SSA no longer requires the “wet” signed paper form, and make sure the claimant understands we will collect and process the information electronically;

• confirm the claimant’s intent to authorize the release of disability related information to SSA; and

• provide and review the penalty clause.

At the conclusion, the SSA employee will attest to the claimant’s intent to sign the SSA-827. The form will automatically upload to the electronic disability folder. SSA requires new EDCS screens to perform the new process. The attached EDCS screens show how we propose to collect the claimant’s authorization via the attestation process.

For internet claims, the claimant will click an internet “submit” button. This action will represent his or her intent to affirm and electronically submit the SSA-827 to SSA. We consider the form signed when submitted, and the system will automatically upload it to the electronic disability folder.

Implementation of the “click and sign” signature proxy requires new internet screens for the i3368 and i3441 (see attached screens).

In situations where we need a new SSA-827 at the Disability Determination Services (DDS) and Office of Disability and Adjudication Review (ODAR), we will use the eView application (see attached eView screens).

The electronic versions of the form will mirror the authorization portion of the paper version with the exception of minor instructional changes based on internet format, e.g., we display the internet version of the SSA‑827 on one page instead of two. We will collect no new information for the electronic SSA-827 as most information is collected on the SSA-3368-BK (Disability Report-Adult, OMB No. 0960-0579) and SSA-3441-BK (Disability report-Appeal, OMB. No. 0960-0144) or on the internet versions of those forms, e.g., name, date of birth, and social security number.

All screens provided are in draft form and are subject to change. We will submit final versions of all screens in a change request once we finalize them.

We expect to implement eAuthorization in calendar year 2012 for first party adult filers. We will continue to expand eAuthorization in the future.

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