Supporting Statement for Form SSA-8011-F3
Statement of Household Expenses and Contributions
20 CFR 416.1130–416.1148
OMB No. 0960-0456
1. Form SSA-8011-F3 is used in the administration of the Supplemental Security Income (SSI) program. Eligibility for SSI is based on need. Need is measured, in part, by the amount of income an individual receives. Income includes in-kind support and maintenance in the form of food and shelter provided by other persons. Section 1612(a)(2)(A) of the Social Security Act (the Act) provides that the benefits of an eligible individual who receives support and maintenance in kind shall be reduced by 33 and 1/3 percent. Section 1631(e) (1) (B) of the Act requires that information used to determine eligibility for SSI benefits must be verified by independent or collateral sources. 20 CFR 416.1130 – 416.1148 of the Code of Federal Regulations provides the procedures and policies for implementing Section 1612(a) (2)(A) of the Act.
2. The Social Security Administration (SSA) uses the information collected on Form SSA-8011-F3 to ensure that an individual is eligible to receive SSI payments and to determine the correct amount of benefits due. The information permits SSA adjudicators to determine the income value, if any, of in-kind support and maintenance received by SSI claimants and beneficiaries. The information collected on the SSA-8011-F3 is readily available to the respondents and requires no special recordkeeping. In addition, this form is not used for all claims and posteligibility determinations. It is used only when it is necessary to document in-kind support and maintenance and only in cases where the householder’s corroboration is needed. Respondents are SSI applicants and beneficiaries.
Improved information technology that would reduce the public burden is not available or feasible as an alternative source of the information collected on Form SSA-8011-F3. This information is not stored on any electronic database and can be obtained only by contacting a member of the SSI beneficiary’s household. An SSA interviewer must complete several case-specific informational blocks on the form before it can be completed correctly by the householder. If the householder downloaded this form directly from the Internet, these blocks would not be completed and the householder would not be able to complete the form accurately. In addition, the information provided could affect SSI eligibility and payment amount and, therefore, this form must be completed and signed only by the appropriate person, i.e., the householder. Accordingly, precautions must be taken to prevent misuse of the form. Unrestricted availability of this form on the Internet may permit usage of this form by people other than the appropriate person and could result in program abuse. For these reasons, SSA has determined that the SSA-8011-F3 is not an appropriate form for implementation on the Internet.
4. The nature of the information being collected and the manner in which it is collected preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.
5. This collection does not have a significant impact on a substantial number of small businesses or other small entities.
6. Collection of the information takes place based on the need of the applicant to apply, or reaffirm eligibility, for SSI payments. Failure to obtain such information, when needed, would prevent SSA from making accurate determinations of eligibility and benefit amounts due, as required by law. Less frequent collection would create a high risk of incorrect SSI eligibility and payment determinations. SSA already limits use of the SSA-8011-F3 by targeting cases in which there is a greater probability of an incorrect determination. In addition, Section 1631(e) (1) (B) of the Act requires that information used to determine eligibility for SSI benefits must be verified by independent or collateral sources. The SSA-8011-F3 is used by SSA to obtain verification from collateral sources. There are no technical or legal obstacles that prevent burden reduction.
7. There are no special circumstances that would cause this information collection to be conducted in a manner that is not consistent with 5 CFR 1320.5.
The 60-day advance Federal Register Notice was published on November 1, 2006 at 71 FR 64327, and SSA has received no public comments. The second Notice was published on January 17, 2007, at 72 FR 2081. There have been no outside consultations with members of the public.
9. SSA provides no payments or gifts to the respondents.
10. The information requested is protected and held confidential 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. The information collection does not contain any questions of a sensitive nature.
12. Form SSA-8011-F3 is used by approximately 400,000 respondents per year. Based on experience using this form over a number of years, we estimate that the burden time is about 15 minutes per response. This results in a total of 100,000 burden hours. This total burden is reflected as burden hours, and no separate cost burden has been calculated.
13. There is no known cost burden to the respondents.
14. The annual cost to the Federal Government is approximately $1,232,000. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
15. There are no changes in the public reporting burden.
16. The results of the information collection will not be published.
17. OMB has granted SSA an exemption from the requirement that the
expiration date for OMB approval is printed on its program forms. SSA
produces millions of public-use forms, many of which have a life cycle
longer than that of an OMB clearance. SSA does not periodically revise
and reprint its public-use forms (e.g., on an annual basis). This exemption
was granted so that otherwise useable editions of forms would not be
taken out of circulation because the expiration date had been reached. In
addition, government waste has been avoided because stocks of forms will
not have to be destroyed and reprinted.
18. SSA is not requesting an exception to the certification requirements.
Please note, however, that statistical survey methodology is not used for
this information collection.
B. Collection of Information Employing Statistical Methods
Statistical methods are not used for this information collection.
| File Type | application/msword |
| File Title | Supporting Statement for Form SSA-8011-F3 |
| Author | OPB |
| Last Modified By | Davidson, Liz |
| File Modified | 2007-01-24 |
| File Created | 2007-01-24 |