Supporting Statement - 0444

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 (Act) requires the Commissioner of the Social Security Administration (SSA) to promulgate regulations concerning applications for Supplemental Security Income (SSI) payments. 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 for SSI payments.

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. We use the paper version of Form SSA-8001-BK when we have a temporary computer failure. In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an electronic version of Form SSA-8001-BK. Based on our data, we estimate approximately 90% of respondents under this OMB number use the electronic version.

In addition, we revising our agency Internet iClaim application (OMB No. 0960‑0618) to allow qualified individuals the ability to submit an online application for SSI disability payments when they complete the iClaim Disability Application. While we account for the additional burden for iClaim users under OMB No. 0960-0618, we account for the burden of asking the remaining questions, which are not currently part of the iClaim process, in #12 below (see Addendum for more details).

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-BK 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

The claimant would not be able to file for benefits if SSA did not collect the information. SSA collects this information on an as needed basis; therefore, 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 May 20, 2016, at 81 FR 31999, and we received no public comments. SSA published the second Notice on November 17, 2016 at 81 FR 81224. In addition, we published an additional second Notice as a correction notice on November 30, 2016 at 81 FR 86374, to correct the burden information for this information collection request. We show the corrected burden in #12 below. 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.

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

Modality of Completion	Number of respondents	Frequency of response	Average burden per response (minutes)	Estimated total annual burden (hours)
MSSICS/Signature Proxy	537,207	1	20	179,069
iClaim/MSSICS	162,945	1	20	54,315
SSA-8001-BK (Paper Version)	1,033	1	20	344
Totals	701,185			233,728

The total burden for this ICR is 233,728. 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 $7,740,296. 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

The decrease in burden hours is due to the upcoming iClaim enhancement that allows a defined group of Title II disability applicants the ability to include an SSI deferred application with their Title II disability iClaim application. Based on the number of Title II disability iClaims filed in FY 2015 that resulted in concurrent applications (Title II disability and Title XVI SSI disability), we are estimating 400,000 Title II disability applicants will be able to include an SSI deferred application with their Title II disability iClaim application. Since iClaim is the collection method for these deferred applications, we are capturing these respondents in the iClaim burden information for OMB No. 0960-0618. However, we are adding a new collection method titled “iClaim/MSSICS” which represents the burden information for SSI deferred applications that originate in iClaim but require SSA to collect additional information from the SSA-8001-BK in MSSICS. We are providing an estimate of 162,945 respondents for this collection method based on the number of Title II disability iClaims filed in FY 2015 that resulted in concurrent applications and became SSI only claims due to technical ineligibility for Title II. We do not expect the burden response time to change for these respondents.

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.