SUPPORTING STATEMENT FOR
MEDICARE MODERNIZATION ACT OUTREACH PROGRAM
(Form SSA-1023 and Phone Call)
20 CFR 418
OMB No. 0960-NEW
Justification
Explain the circumstances that make the collection of the information necessary, and identify any legal or administrative requirements that mandate the collection.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), P.L. 108-173, created a voluntary prescription drug benefit program under the new Medicare Part D. The MMA stipulates that Medicare beneficiaries who meet income and resource limits are eligible to receive a subsidy for this program. Medicare beneficiaries who are not automatically enrolled in the subsidy program may apply to the Social Security Administration (SSA) for subsidy consideration using form SSA-1020 (OMB No. 0960-0696), the Application for Help with Medicare Prescription Drug Plan Costs. The provisions of the MMA are codified in section 20 CFR 418 of the Code of Federal Regulations.
To promote awareness of the program and encourage potentially eligible Medicare beneficiaries to complete the SSA-1020, SSA plans to explore a new method of outreach, the Medicare Modernization Act Outreach Mailer. This combination mailer/brochure will serve as a call to action for those who might have missed the initial campaign or who do not understand their potential eligibility for the extra help. We are marketing the brochure to Medicare recipients, as well as their family members, friends and professional care givers.
SSA plans to conduct a brief follow-up phone call with those Medicare recipients who saw the MMA Outreach Mailer and requested form SSA-1020, but did not return a completed form. The purpose of the phone call is to encourage these Medicare recipients to apply for the subsidy. This Information Collection Request is for the MMA Outreach Mailer and the follow-up phone call. Section 205 of the Social Security Act gives us the authority to collect this information.
Indicate how, by whom, and for what purpose the information is to be used.
Ultimately, SSA will use the information it will obtain through this collection to identify potentially eligible beneficiaries for the Medicare Part D subsidy, and to encourage them to complete and submit the SSA-1020 subsidy application form.
Methodology
The Medicare Modernization Mailer Insert (form SA-1023) will be on display in various locations around the country, including local and national chain pharmacy counters, doctors’ offices, medical clinics, etc. This display will consist of a cardboard foldout brochure advertising form SSA-1020; the brochure will contain SSA-1020 Medicare Modernization Mailer Inserts.
The public can remove the Medicare Modernization Mailer Insert (SSA-1023), complete it at their convenience, and mail it to SSA in the pre-addressed, postage paid envelope provided with the insert. The insert will ask for the following information: First Name, Last Name, Street Address/Apt #, City, State, Zip Code, Social Security Number, and Phone Number. Once SSA receives the completed form, our system will scan the contact information provided and mail a Medicare Part D Subsidy Application to the Medicare beneficiary. When the beneficiary returns the completed SSA-1020 to SSA, the Agency can respond and conduct timely follow-ups.
If beneficiaries do not return a completed SSA-1020, SSA will contact them via phone to remind them about the form and encourage them to return and complete it. Beneficiaries will not speak with an actual SSA employee; rather, they will hear a recorded message from the Medicare Automated Reminder System (MRS) Message system.
Please see the attached document, “MMA Outreach Phone Message,” for the exact text of this message.
Data Collection Procedures
Telephone calls will be conducted during normal business hours across the nation. The calls will be made 45 days after the SSA -1020 is mailed out. When necessary, the MRS system will make two attempts to contact the beneficiaries, once in the morning and again in the evening of the same day. The same automated message will be used for both attempts.
If the MMA Outreach Mailer/Phone Call system seems effective, we anticipate it will be an ongoing initiative.
Describe whether the collection of information involves the use of information technology (permitting electronic submission of responses) and if so, what percentage of information is collected electronically.
The nature of this mailer/phone call is such that the requirements of the Government Paperwork Elimination Act do not apply, so there is no electronic version of this collection. However, respondents can complete and submit the actual SSA-1020 electronically.
Describe efforts to identify duplication.
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.
State whether the information collection has a significant economic impact on a substantial number of small businesses or other small entities.
This collection does not impact small businesses or other small entities.
Describe the impact on Federal program or policy activities if the information collection were not conducted or if it were conducted less frequently. Describe any technical or legal obstacles to reducing burden.
If this ongoing collection was not conducted, SSA would lose a valuable means of reaching many potentially eligible Medicare Part D beneficiaries and encouraging them to apply for the subsidy. Since we are only collecting the information once, we cannot collect it less frequently.
There are no technical or legal obstacles that prevent burden reduction.
Explain any circumstances that would cause the information collection to be conducted in an unusual manner (ex: requiring respondents to respond to the Agency frequently, requiring respondents to submit multiple copies of a document, etc.).
There are no special circumstances that would cause this information collection to be conducted in a manner inconsistent with 5 CFR 1320.5.
Give the date and citation number for the Federal Register Notice(s). Describe any public comments received in response to the FRN. Describe any consultation with members of the public, if applicable.
SSA published the 60-day Advance Federal Register Notice on March 26, 2008, at 73 FR 16087, and we received no public comments. We published the 30-day Federal Register Notice on June 2, 2008, at 73 FR 31530. We will forward any public comments we may receive in response to this Notice to OMB.
We did not conduct any outside consultations with members of the public.
Decision to provide payment/gift to respondents.
SSA provides no payment or gifts to the respondents.
Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or Agency policy.
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.
Provide additional justification for any questions of a sensitive nature, if applicable.
This information collection does not contain any questions of a sensitive nature.
Provide estimates of the hour burden for the collection of information, including the number of respondents, frequency of response, and annual hour burden.
See below for this ICR’s burden data. The total burden is reflected as burden hours, and no separate cost burden has been calculated.
|
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Annual Burden (hours) |
Mailer Insert (Form SSA-1023) |
75,000 |
1 |
1 |
1,250 |
Follow-Up Phone Calls |
30,000 |
1 |
1 |
500 |
Totals |
105,000 |
- |
- |
1,750 hours |
Describe the cost, if any, to the respondents for participating in this information collection.
There is no known cost burden to the respondents.
Provide estimates of the annual cost of this collection to the Federal Government to collect this information, including a description of the method used to estimate cost.
The cost estimate for printing and distributing form SSA-1023 is $180,348.00.
State whether this collection imposes a new, altered, or unchanged public reporting burden.
This is a new ongoing information collection that will increase the public reporting burden by 1,750 hours.
State whether the results of the information collection will be published and give details, if necessary.
SSA will not publish the results of the information collection.
If seeking approval not to display the expiration date for OMB approval of the information collection explain why displaying the date would be in appropriate.
OMB has granted SSA an exemption from the requirement that the expiration date for OMB approval be 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 approval. 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.
As part of the clearance process, the agency must certify to OMB that the collection of information meets the appropriate provisions.
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).
Collections of Information Employing Statistical Methods
If statistical methods are used for this information collection, describe potential respondent universe, statistical analysis procedures, etc.
We did not use statistical methods for this information collection.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT FOR |
| Author | 572868 |
| Last Modified By | 666429 |
| File Modified | 2008-06-06 |
| File Created | 2008-06-02 |