Supporting Statement - 0723

Supporting Statement for

Redetermination of Eligibility for Extra Help

With Medicare Prescription Drug Plan Costs

Forms SSA-1026-REDE

(Social Security Administration Review of Your Eligibility for Extra Help)

And

SSA-1026-SCE

(Social Security Administration Reporting a Change That May Affect Your Extra Help)

20 CFR 418.3125

OMB No. 0960-0723

1. Justification

1. Introduction/Authoring Laws and Regulations

Section 1860D-14(a)(3)(A)(iv)(I) of the Medicare Modernization Act (MMA) of 2003, as codified in Section 418.3125 of the Code of Federal Regulations, requires the Social Security Administration (SSA) to conduct low-income subsidy eligibility redeterminations for recipients of the Medicare Prescription Drug Plan (Part D) subsidy. SSA needs forms to collect information from subsidy recipients so we can: (1) determine if a subsidy redetermination is necessary, and (2) conduct the actual redetermination. The agency uses Forms SSA-1026-REDE and SSA‑1026‑SCE for these purposes.

2. Description of Collection

Medicare Part D subsidy recipients undergo an eligibility redetermination under two potential circumstances. Below is a description of these scenarios and the appropriate forms to use. This collection is mandatory for respondents who wish to continue their Medicare Part D subsidy. SSA employees collect this information.

SSA-1026-REDE (Social Security Administration Review of Your Eligibility for Extra Help)

Form SSA-1026-REDE is a cyclical redetermination form SSA sends to certain Medicare Part D subsidy recipients whom the system automatically selects based on certain profile and selection criteria. Specifically, these are individuals who: (1) became entitled to the Medicare Part D subsidy during the past 12 months; (2) were eligible for the Part D subsidy for more than 12 months; or (3) reported a change in income, resources, or household size (all factors which could affect subsidy amounts).

SSA-1026-SCE (Social Security Administration -- Reporting a Change That May Affect Your Extra Help)

SSA uses form SSA-1026-SCE to conduct subsidy eligibility redeterminations for Part D subsidy beneficiaries who report a potentially subsidy-changing event, including the following: (1) marriage; (2) spousal separation; (3) divorce; (4) annulment of a marriage; (5) spousal death; or (6) moving back in with one’s spouse following a separation. SSA sends the form to Medicare Part D subsidy recipients who have contacted SSA to self-report one of these events.

When SSA mails these forms to recipients, SSA includes a Resource and Income Summary form. This insert lists the subsidy-eligible individual’s income and resource types; income and resources amounts; and the household size on record. This information comes from (1) SSA’s records, and (2) the information subsidy recipients provided on their original applications. SSA asks the subsidy recipient undergoing a redetermination to refer to the Resource and Income Summary when completing the SSA-1026.

The respondents are current recipients of the Medicare Part D low-income subsidy who will undergo an eligibility redetermination.

3. Use of Information Technology to Collect the Information

A PDF version of Form SSA-1026 is available on SSA’s website for viewing purposes only. The respondents can complete the paper form, or a field office representative completes the form during an in-office or telephone interview, and enters the information in an SSA Intranet application system.

In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Intranet version of the SSA-1026 forms. Based on our data, we estimate approximately 34 percent of respondents under this OMB number use the electronic version.

4. Why We Cannot Use Duplicate Information

The nature of the information we collect and the manner in which we collect 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 SSA did not conduct this information collection, we would have no means of conducting mandatory annual redeterminations; periodic subsidy eligibility redeterminations; or subsidy eligibility redeterminations for those reporting subsidy-changing events, which would be in violation of the relevant provisions of the MMA. 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 August 16, 2017, at 82 FR 38982, and we received no public comments. The 30-day FRN published on November 9, 2017 at 82 FR 52088. If we receive any comments in response to this Notice, we will forward them to OMB.

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 Collection	Number of Respondents	Frequency of Response	Average Burden per Response (minutes)	Estimated Total Annual Burden (hours)
SSA-1026-REDE	98,990	1	18	29,697
SSA-1026-SCE	4,267	1	18	1,280
REDE Field Office Interview	50,529	1	18	15,159
SCE Field Office Interview	3,468	1	18	1,040
Totals	157,254			47,176

The total burden for this ICR is 47,176 hours. We based these figures on current management information data. 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 the Federal Government

The annual cost to the Federal Government is approximately $552,426. This estimate accounts for costs from the following areas: (1) designing, printing, and distributing the form; (2) SSA employee (e.g., field office, 800 number, DDS staff) information collection and processing time; and (3) systems development, updating, and maintenance costs.

15. Program Changes or Adjustments to the Information Collection Request

The decrease in burden hours stems from a decrease in the number of respondents, due to SSA conducting fewer redeterminations.

16. Plans for Publication Information Collection Results

SSA will not publish the results of this information collection.

17. Displaying the OMB Approval Expiration Date

OMB granted SSA an exemption from the requirement to print the OMB approval date on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that 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 that we 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).

2. Collections of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.