Supporting Statement for Form SSA-L5061
Letter to Landlord Requesting Rental Information
20 CFR 416.1130(b)
OMB No. 0960-0454
A. Justification
1. Section 1612(a)(2)(A) of the Social Security Act (the Act) provides that the benefits of an eligible individual who receives in-kind support and maintenance shall be reduced by 33 and 1/3 percent. Section 1631(e)(1)(B) of the Act further requires that the Social Security Administration (SSA) must verify information used to determine eligibility for Supplemental Security Income (SSI) benefits by independent or collateral sources. Part 20 CFR 416.1130(b) of the Code of Federal Regulations describes the circumstances under which SSA may consider in-kind support and maintenance from a rental subsidy.
2. SSA uses the information from the Form SSA-L5061 to identify rental subsidy arrangements for individuals who apply for SSI benefits and individuals who are already getting SSI benefits. The information enables SSA to determine and verify an income value for these subsidies. SSA uses this income value to determine eligibility for benefits and the correct amount of benefits payable. SSA uses this form in the administration of the SSI program. SSA bases an individual’s eligibility for SSI benefits on need, which SSA measures, in part, by the amount of income an individual receives. Income includes in-kind support and maintenance in the form of room or rent, such as a subsidized rental arrangement.
3. An implementation date for an Internet version has not been determined for this form due to an elevated risk of payment error and the low volume of usage of this form. The information collected is not available on any electronic database. The respondents are landlords of SSI beneficiaries.
The estimate of 49,000 collections includes the respondents for cases processed in the Modernized SSI Claim System (MSSICS). The SSA Claims Representative records the rental subsidy information collected by the SSA-L5061 on the MSSICS LRNT screen. Approximately ninety percent of the data collected on rental subsidy arrangements for SSI purposes is electronic.
4. The nature of the information SSA is collecting and the manner in which we are collecting it preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.
This collection has no impact on small businesses or other small entities. All of the respondents are landlords of the SSI recipients. The landlords SSA contacts are always close relatives of the SSI applicant or recipient, so we are not contacting any landlords in their capacity as a small business.
6. SSA based the collection of the information on the need of the individual to apply or reaffirm eligibility for SSI payments. The agency's failure to obtain such information would prevent the agency from making accurate determinations of eligibility and benefit amounts as required by statute. Less frequent collection could create a high risk of incorrect SSI eligibility and payment determinations. SSA limits the use of this form to only cases where rental subsidy may exist since it could affect an SSI applicant or recipient’s eligibility or benefit amount. The individual’s landlord is the only source for this information and SSA can only obtain it by contacting the landlord. Therefore, SSA cannot collect the information less frequently.
7. There are no special circumstances that would cause SSA to collect this information in a manner that is not consistent with 5 CFR 1320.5.
8. SSA published the 60-day advance Federal Register Notice on August 22, 2008, at 73 FR 49730, and SSA has received no public comments. SSA published the 30-Day Notice on October 27, 2008, at 73 FR 63761. If we receive any public comments in response to the 30-Day Notice, we will forward them to OMB. The Federal Register notices indicate this is a request for extension of OMB’s approval. However, subsequent to publication, we updated the Privacy Act notice and are submitting this ICR as a revision.
SSA has made no outside consultations with members of the public.
9. SSA provides no payment or gifts to the respondents.
10. The information requested on this form 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-L5061 will be used by approximately 49,000 respondents annually.
The estimated average response time is 10 minutes, for a total of 8,l67 burden hours. The total burden represents burden hours, and we did calculate a separate cost burden. The estimate of 49,000 respondents includes both the respondents SSA contacts by telephone and those to whom SSA mailed the paper form.
13. There is no known cost burden to the respondents.
14. The annual cost to the Federal government is approximately $226,380. This estimate is a projection of the costs for printing and distributing the form and for collecting the information.
15. There are no program changes or adjustments in this form and there is no change in the public reporting burden.
SSA will not publish the results of the information collection.
17. OMB exempted SSA from publishing the expiration date for OMB approval 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). OMB granted this exemption so that SSA would not have to stop using otherwise useable editions of forms with outdated expiration date. In addition, SSA avoids Government waste because we do not have to destroy and reprint stocks of forms.
18. 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).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/msword |
| File Title | Letter to Landlord Requesting Rental Information |
| Author | OPB |
| Last Modified By | Davidson, Liz |
| File Modified | 2008-11-20 |
| File Created | 2008-11-20 |