Addendum - 0516

Addendum to Supporting Statement for

Continuation of Supplemental Security Income Payments for the Temporarily Institutionalized – Certification of Period and Need to Maintain Home

20 CFR 416.212(b)(1)

OMB No. 0960-0516

Background

SSA currently requests the information regarding continuation of Supplemental Security Income payments for recipients who are temporarily institutionalized from the public through our regulatory requirements with no standardized form. However, we received a public comment from SSA Advocates Workgroup informing the agency that many of their customers had a hard time creating the documents needed to qualify for Temporary Institutionalization Benefits and requested that we create a more standardized document for respondents to use. To that end, we created a new form, the SSA-186, Temporary Institutionalization Statement to Maintain Household and Physician Certification, for respondents to use if they prefer to submit this information using a standardized form. We still accept this information in writing as we did previously. However, we will now also accept this form for those respondents who prefer to use it.

Based on our usability testing of this form, we do not expect any changes to the burden information for respondents using the form.

Revisions to the Collection

• Change #1: We created the SSA-186, Temporary Institutionalization Statement to Maintain Household and Physician Certification. The SSA-186 reflects the same questions already within the SSI Claims System screens to document Temporary Institutionalization benefits.

Justification#1: As we mentioned above, the SSA Advocates Workgroup informed SSA that many of their customers had a hard time creating the documents needed to qualify for Temporary Institutionalization Benefits. Therefore, SSA created a form that can be used by recipients, representative payees, and institutions to obtain the statement of need and the physician’s certification on one document.

SSA will implement these changes upon OMB’s approval.

This action does not affect the public reporting burden.