Supporting Statemet 0444 (revised)

Supporting Statement for Form SSA-8001-BK

Application for Supplemental Security Income

20 CFR 416.305 - 20 CFR 416.335, Subpart C

OMB No. 0960-0444

A. Justification

1. Introduction/Authoring Laws and Regulations

Section 1631(e)(1) of the Social Security Act (the Act) requires the Commissioner of the Social Security Administration (SSA) 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 information we request for SSI benefits be on a prescribed form.

2. Description of Collection

SSA uses Form SSA-8001-BK to determine an applicant’s eligibility for SSI and the SSI payment amounts. SSA employees also collect this information during interviews with members of the public who wish to file for SSI. SSA uses the information for two purposes: (1) to formally deny SSI for non-medical reasons when information the applicant provides results in ineligibility; or (2) to establish a disability claim, but defer the complete development of non-medical issues until SSA approves the disability. The respondents are applicants of SSI.

2. Use of Information Technology to Collect the Information

SSA uses the Modernized Supplemental Security Income Claims System (MSSICS) to document information we obtain from the claimant. The technician collects the information during the interview and enters it into MSSICS. We transitioned the proxy and non-proxy application. MSSICS cases and MSSIC/signature proxy are now the same.

In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Internet PDF version of Form SSA-8001. Based on our most recent data, we estimate approximately 90% of respondents under this OMB number respond electronically.

2. Why We Cannot Use Duplicate Information

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. We use Form SSA-8001-BK over Form

SSA-8000 when we are taking an abbreviated application (i.e., claimants does not meet the non-medical requirements and they will be denied for that reason). We use Form SSA-8001 when we will defer non-medical development until after we get a medical decision. However, the respondent only has to complete one form. Therefore, respondents only have to provide the information once.

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-8001-BK, the claimant would not be able to file for benefits. Because we collect this information on an as needed basis, 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

The 60-day advance Federal Register Notice published on March 19, 2014, at 80 FR 14432, and we received no public comments. The 30-day FRN published on May 22, 2015 at 80 FR 29787. If we receive any comments in response to this Notice, we will forward them to OMB. We did not consult with the public in the revision of this form.

Comment: We received comments from the Family Equality Council, recommending SSA to amend Form SSA-8001-BK to eliminate all gender parental language.

SSA Response: SSS is in the process of revising Form SSA-8001-BK to remove the gender terms from Question 9 of the form. Once the revision is complete, we will also review and consider removing the gendered terms from Question 27, which is the current number of the question referred to in the attached letter as Question 24.

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

Collection Method	Number of respondents	Frequency of response	Average burden per response (minutes)	Estimated total annual burden (hours)
MSSICS/Signature Proxy	1,195,521	1	20	398,507
Non-MSSICS (Paper)	140,145	1	20	46,715
Totals	1,335,666			445,222

The total burden for this ICR is 445,222 hours. This figure represents burden hours, and 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 is approximately $11,017,777. This estimate is a projection of the costs for printing and distributing the collection instrument, conducting interviews, and processing.

15. Program Changes or Adjustments to the Information Collection Request

There is an increase in burden hours, this change stems from an increase in the number of respondents applying for benefits.

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.

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