Supporting Statement - 0454

Supporting Statement for Form SSA-L5061

Letter to Landlord Requesting Rental Information

20 CFR 416.1130(b)

OMB No. 0960-0454

A. Justification

1. Introduction/Authoring Laws and Regulations
   Section 1612(a)(2)(A) of the Social Security Act (Act) provides for a reduction by 33 and 1/3 percent of the Supplemental Security Income (SSI) payments for eligible individuals who receive in-kind support and maintenance. Section 1631(e)(1)(B) of the Act further requires the Social Security Administration (SSA) to verify information used to determine eligibility for SSI payments by independent or collateral sources. Part 20 CFR 416.1130(b) of the Code of Federal Regulations describes the circumstances under which SSA may consider in-kind support and maintenance from a rental subsidy. To identify rental subsidy arrangements for individuals who apply for SSI payments, and individuals who currently receive SSI payments, SSA uses the information from Form

SSA-L5061, Letter to Landlord Requesting Rental Information.

2. Description of Collection
SSA uses Form SSA-L5061 to obtain rental subsidy information, which enables the agency to determine and verify an income value for these subsidies. We use this income value to determine eligibility for SSI and the correct amount of SSI payable to the claimant. SSA bases an individual’s eligibility for SSI payments, in part, on the amount of countable income the individual receives. Income includes in-kind support and maintenance in the form of room or rent, such as a subsidized rental arrangement. SSA requires claimants to assist in obtaining this information to prevent a delay or overpayment with their SSI payments. We collect this information only if the SSI applicant or recipient is the parent or child of the landlord (respondent). For most respondents, we collect this information once per year or less, via telephone or face-to-face personal interview. The claims representative records the information in our Modernized SSI Claims System (MSSICS), and we require verbal attestation in lieu of a wet signature. However, if the claim representative is unable to contact the respondent via the telephone or face-to face, we print and mail a paper form to the respondent for completion. The respondent completes, signs, and returns the form to the claim representative. Upon receipt, the claims representative documents the information in MSSICS or, for non-MSSICS cases, faxes the form into the appropriate electronic folder and shreds the paper form. The respondents are landlords who are related to the SSI beneficiaries as a parent or child.

3. Use of Information Technology to Collect the Information
In accordance with the agency’s Government Paperwork Elimination Act plan, 95% of respondents provide the rental subsidy information in person or by telephone to the SSA claims representative who then records it electronically in MSSICS. The remainder of respondents use a printed copy of the electronic version mailed to them by the SSA claims representative. We did not create an Internet version of this form as we prioritize higher volume collections for electronic implementation. Regardless of whether the respondents complete the paper form, or participate in a personal interview, the claims representatives record 100 percent of the data regarding rental subsidy arrangements either electronically in MSSICS or by faxing the paper form into the electronic claims folder.

4. Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it precludes 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. The landlords we contact are always close relatives of the SSI applicant or recipient, so we are not contacting any landlords in their capacity as a small business.

5. Consequence of Not Collecting Information or Collecting it Less Frequently
   SSA based the collection of the information on the need of the individual to apply or reaffirm eligibility for SSI payments. The agency's failure to obtain this information would prevent the agency from making accurate determinations of eligibility and payment amounts as required by statute. Less frequent collection could create a high risk of incorrect SSI eligibility and payment determinations. However, SSA limits the use of this form to only those cases where rental subsidy may exist since it could affect an SSI applicant or recipient’s eligibility or payment. The individual’s landlord is the only source for this information, and SSA can only obtain it by contacting the landlord. Therefore, SSA cannot collect the information 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 collect this information in a manner that is not consistent 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 February 28, 2017, at 82 FR 12159, and we received no public comments. SSA published the second Notice on May 12, 2017, at 82 FR 22173. If we receive comments in response to the 30-day Notice, we will forward them to OMB. We did not consult with the public in the revision of this form.

9. Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.

10. 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).

11. Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.

12. Estimates of Public Reporting Burden

Modality of Completion	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Estimated Total Annual Burden (hours)
SSA-L5061	72,000	1	10	12,000

The total burden for this ICR is 12,000 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 estimated cost to the Federal Government to collect the information is negligible. Because the cost of maintaining the system which collects this information is accounted for within the cost of maintaining all of SSA’s automated systems, it is not possible to calculate the cost associated with just one Intranet form.

15. Program Changes or Adjustments to the Information Collection Request
    There are no changes to the pubic reporting burden.

15. 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.

15. 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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