Early Use Survey

Accelerated Benefits Demonstration Project

Appendix F

Early Use Survey

OMB: 0960-0747

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(SSA Letterhead)

6-Month Follow-Up Survey)


Date



Dear __________:


About six months ago, you completed an interview as part of the Accelerated Benefits (AB) Demonstration being sponsored by the Social Security Administration. You may remember that at that time we said that we would call you again to see how you’re doing since you started receiving Social Security Disability benefits.


This letter is to let you know that an interviewer from Mathematica Policy Research (MPR) will be calling in a few days to interview you. The interview will take about 30 minutes to complete. To thank you for completing the interview, we will send you $25. Your opinions and experiences are very important to us.


As before, the information we collect is completely confidential. It will be used for research purposes only. Your name will never be used in any reports. All of the people working on this study are trained to protect your privacy and must sign a privacy pledge.


Thank you in advance for completing this important survey when the interviewer calls. If you have any questions about the survey, please call MPR toll free at 866-275-8659 and ask for Amy Bates. We look forward to speaking with you soon.


Best Wishes,



David Butler,

Project Director,

Accelerated Benefits Demonstration

ON REVERSE SIDE OF THIS LETTER


Privacy Act Statement -- The Privacy Act requires us to notify you that we are authorized to collect this information by section 702 of the Social Security Act. You do not have to provide the information requested. However, the information you provide will allow the Social Security Administration (SSA) to better foster independence and community participation among persons with disabilities. The person(s) completing the interview will remain anonymous.


Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. The OMB control number for this study is 0960-0526. We estimate that it will take about 30 minutes to participate in this activity. Send only comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401.



DRAFT /home/ec2-user/sec/disk/omb/icr/200705-0960-002/doc/2792501 2 02/05/21 7:07 PM

File Typeapplication/msword
File TitleMEMORANDUM
AuthorJulita Milliner-Waddell
Last Modified ByFaye
File Modified2007-05-10
File Created2007-05-10

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