Supporting Statement - 0229

Supporting Statement for Form SSA-8000-BK

Application for Supplemental Security Income

20 CFR, 416.207 & 416.305-416.335, Subpart C

OMB No. 0960-0229

A. Justification

1. Introduction/Authoring Laws and Regulations

Section 1631(e)(1) of the Social Security Act (Act) requires the Commissioner of the Social Security Administration (SSA) to issue regulations on applying for Supplemental Security Income (SSI). SSI is a Federal income supplement program funded by general tax revenues (not Social Security taxes). SSI provides aged, blind, and disabled people who have little or no income, with the funds for food, clothing, and shelter. Section 20 CFR, 416.207 and 416.305-416.335 prescribe SSA’s authority to collect the information we need to determine a claimant’s eligibility for SSI.

2. Description of Collection

The SSI program provides aged, blind, and disabled individuals who have little or no income with funds for food, clothing, and shelter. Individuals either complete Form SSA-8000-BK using the paper form, or via personal interview with a claims representative using the electronic Modernized SSI Claims System (MSSICS) to apply for SSI. SSA uses the information gathered from the SSA‑8000-BK to: (1) determine whether claimants meet all statutory and regulatory requirements for SSI eligibility; and (2) calculate SSI payment amounts. The respondents are SSI applicants or their representative payees.

3. Use of Information Technology to Collect the Information

SSA uses the Modernized Supplemental Security Income Claims System, or MSSICS, to record the information from respondents. SSA completes approximately 98 percent of SSI applications using MSSICS.

4. Why We Cannot Use Duplicate Information

The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to obtain similar data.

5. Minimizing Burden on Small Respondents

This collection does not affect small businesses or other small entities.

6. Consequence of Not Collecting Information or Collecting it Less Frequently

If we did not use Form SSA-8000, the public would have no vehicle with which to apply for SSI. This would be a violation of regulations at Section 20 CFR, 416.207 and 416.305-416.335. Because we only collect the information once, we cannot collect it less frequently. There are no technical or legal obstacles to burden reduction.

7. Special Circumstances

There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.

8. Solicitation of Public Comment and Other Consultations with the Public

SSA published the 60-day advance Federal Register Notice on August 7, 2014, at 79 FR 46293, and we received no public comments. We published the 30-day Federal Register Notice on October 10, 2014, at 79 FR 61366. If we receive any public comments in response to the 30-day Notice, we will forward them to OMB. We did not consult with members of the public regarding this information collection.

8. Payment or Gifts to Respondents

SSA does not provide payments or gifts to the respondents.

8. Assurances of Confidentiality

SSA protects and holds confidential the information it collects 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.

8. Justification for Sensitive Questions

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

8. Estimates of Public Reporting Burden

We collect the information from approximately 1,964,769 respondents annually for a total burden of 1,153,573 hours. Approximately 98 percent of the claims are MSSICS claims (i.e., claims taken during a personal interview), and 89 percent use signature proxy. Signature proxy allows an SSA employee to sign the claim electronically through attestation, with the consent of the applicant. A breakdown of the burden is as follows:

Type of Response	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Total Annual Burden (hours)
Paper	39,295	1	41	26,852
MSSICS	211,802	1	36	127,081
MSSICS w/ Signature Proxy	1,713,671	1	35	999,641
Totals	1,964,768			1,153,574

The total burden reflects burden hours; we did not calculate a separate cost burden.

13. Annual Cost to the Respondents (Other)

This collection does not impose a known cost burden on the respondents.

14. Annual Cost To Federal Government

The annual cost to the Federal Government for the paper application form is approximately $352,856. This estimate is a projection of costs for printing and distributing the form.

15. Program Changes or Adjustments to the Information Collection Request

There was an increase in the number of respondents to the information collection report resulting in an increase of the total annual burden hours. Our new burden is based on the current MI data.

16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

17. Displaying the OMB Approval Expiration Date

OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste    .

18. Exceptions to Certification Statement

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 does not use statistical methods for this information collection.