Statement for Determining Continuing Eligibility for Supplemental Security Income Payments, 20 CFR 416.204

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-8203 Statement Determining Continuing Eligibility for Supplemental Security Income Payments	Form	Unchanged	Available
MSSICS Screen Mockup.doc	Supplementary Document	Uploaded 2008-05-20	Available
Justification for Revision--Background-Direct Express.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2008-05-20	Available
Supporting Statement SSA-8203 02-26-07 F.doc	Supporting Statement A	Uploaded 0000-00-00	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37987	Statement for determining continuing eligibility for Supplemental Security Income Payments -- MISSIC Screens Signature Proxy	Other-MISSICS Screens Signature Proxy	Unchanged
178984	Determining Continuing Eligibility for Supplemental Security Income Payments – Hardcopy Form	Form	Unchanged	Statement Determining Continuing Eligibility for Supplemental Security Income Payments
178983	Statement for Determining Continuing Eligibility for Supplemental Security Income Payments –MISSIC Screens		Unchanged

ICR Details

OMB Control No: 0960-0416	ICR Reference No: 200805-0960-020
Status: Historical Active	Previous ICR Reference No: 200702-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement for Determining Continuing Eligibility for Supplemental Security Income Payments, 20 CFR 416.204
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/20/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/20/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2010	05/31/2010	05/31/2010
Responses	171,000	0	171,000
Time Burden (Hours)	56,394	0	56,394
Cost Burden (Dollars)	0	0	0

---

Abstract: Form SSA-8203-BK is used in high-error probability (HEP) redeterminations cases to determine whether SSI recipients continue to meet requirements for SSI eligibility, and whether they are receiving the correct payment amount. The information is normally completed in field offices via personal contact using the automated Modernized SSI Claims System (MSSICS). The paper form is used only when a systems limitation prevents the interview from being completed on MSSICS. Respondents are recipient of title XVI SSI benefits.

---

Authorizing Statute(s): US Code: 42 USC 1382a
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 75607	12/15/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 12244	03/15/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments –MISSIC Screens
Determining Continuing Eligibility for Supplemental Security Income Payments – Hardcopy Form	SSA-8203	Statement Determining Continuing Eligibility for Supplemental Security Income Payments
Statement for determining continuing eligibility for Supplemental Security Income Payments -- MISSIC Screens Signature Proxy

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	171,000	171,000	0	0	0	0
Annual Time Burden (Hours)	56,394	56,394	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There actually is no change in the overall burden or respondents to this ICR. However, to effectively illustrate the burden in ROCIS SSA divided the ICR into 3 separate ICs which reflect the 3 collection methods associated with this activity.

---

Annual Cost to Federal Government: $11,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/20/2008

---