Addendum - 0010

Addendum to the Supporting Statement for Form SSA-4-BK

Application for Child’s Insurance Benefits

20 CFR 404-350 – 404.368 and 404.603, CFR 414.350

OMB No. 0960-0010

Revision to the Collection Instrument

SSA is making the following revisions:

• Change #1: We removed the stand-alone MCS collections.

Justification #1: We did this because the MCS estimates are included in the MCS/Signature Proxy collection, and SSA requires attestation (signature proxy) from all interviewees using MCS.

Revision to the Collection Instrument – Form SSA-4-BK

• Change #1: Page 1, Question 3: We are inserting a header above the bullets in the left column.

From:

• Under age 18

• Age 18 to 19 and attending elementary

or secondary school full-time

• Disabled or Handicapped (age 18 or

over and disability began before age 22)

To:

List below all children who are:

• Under age 18

• Age 18 to 19 and attending elementary

or secondary school full-time

• Disabled or Handicapped (age 18 or

over and disability began before age 22)

Justification #1: We made this change so the reader can better understand the significance of the bullets.

• Change #2: Page 1, Question 3: Column 4 from the left in the chart. We are updating the age to 17.5 years.

From:

Check (X) if Child

17 or older is:

To:

Check (X) if Child

17.5 or older is:

Justification #2: We updated the age to 17.5 years to align with policy in RS 00203.070: Documenting the Application for Child’s Insurance Benefits, Form SSA-4-BK.

• Change #3: Page 9, under “Changes To Be Reported and How To Report”. Left column, 7^th bullet. We need to revise the bullet.

From:

• The child age 13 or older has an unsatisfied warrant for more than 30 days for his or her arrest, or a crime or attempted crime that is a felony of flight to avoid prosecution or confinement, escape from custody, and flight escape. In most jurisdictions that do not classify crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding one year.

To:

• The child age 13 or older has an unsatisfied felony or arrest warrant for more than 30 continuous days for flight to avoid prosecution or confinement, escape from custody, or flight-escape.

Justification #3: We are revising the reporting instruction language to match the language on other SSA paper applications. We now used the term “arrest warrant” to cover jurisdictions that do not classify crimes as felonies.

• Change #4: Page 9, under “Changes To Be Reported and How To Report.” Right Column, 1^st bullet. We need to delete the current bullet:

• The child age 13 or older has more than 30 continuous days committed a violation of probation or parole under Federal or State law.

Justification #4: We need to delete this entire bullet. On August 4, 2015, SSA decided we would no longer suspend benefits or stop payments to Title II beneficiaries and Title XVI recipients if the beneficiary or recipient alleged having an unsatisfied violation of probation or parole under Federal or State law (SSA based this decision on extensive research and studies). Based on the Office of General Counsel’s recommendation, SSA decided we would no longer enforce the probation or parole violation (PPV) non-payment sections of the Social Security Act because the statute, as currently constructed, is flawed and not susceptible to implement given the restrictions placed on the Agency by the Clark Court Order.

• Change #5: We are revising the Privacy Act Statement on this form.

Justification #5: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.

Revision to the Collection Instrument – Form SSA-4-INST

• Change #1: Page 1, Left Column, 7^th bullet. We need to revise the bullet.

From:

• The child age 13 or older has an unsatisfied warrant for more than 30 days for his or her arrest, or a crime or attempted crime that is a felony of flight to avoid prosecution or confinement, escape from custody, and flight escape. In most jurisdictions that do not classify crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding one year.

To:

• The child age 13 or older has an unsatisfied felony or arrest warrant for more than 30 continuous days for flight to avoid prosecution or confinement, escape from custody, or flight-escape.

Justification #1: We are revising the reporting instruction language to match the language on other SSA paper applications. We now used the term “arrest warrant” to cover jurisdictions that do not classify crimes as felonies.

• Change #2: Page 1, Left column, 8^th bullet. We need to delete the bullet.

• The child age 13 or older has more than 30 continuous days committed a violation of probation or parole under Federal or State law.

Justification #2: We need to delete this entire bullet. On August 4, 2015, SSA decided we would no longer suspend benefits or stop payments to Title II beneficiaries and Title XVI recipients if the beneficiary or recipient alleged having an unsatisfied violation of probation or parole under Federal or State law (SSA based this decision on extensive research and studies). Based on the Office of General Counsel’s recommendation, SSA decided we would no longer enforce the probation or parole violation (PPV) non-payment sections of the Social Security Act because the statute, as currently constructed, is flawed and not susceptible to implement given the restrictions placed on the Agency by the Clark Court Order.

• Change #3: We are revising the Privacy Act Statement on this form.

Justification #3: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.