0960-0723 supporting statement

SUPPORTING STATEMENT FOR FORMS SSA-1026-REDE (Social Security Administration Review Of Your Eligibility For Extra Help) and SSA-1026-SCE (Social Security Administration Reporting A Change That May Affect Your Extra Help)

REDETERMINATION OF ELIGIBILITY FOR EXTRA HELP WITH MEDICARE PRESCRIPTION DRUG PLAN COSTS

20 CFR 418.3125

OMB No. 0960-0723

1. Justification

1. Need for the Information Collection and Legal/Administrative Justification

Section 1860D-14(a)(3)(A)(iv)(I) of the Medicare Modernization Act of 2003, as codified in section 418.3125 of the Code of Federal Regulations, requires the Social Security Administration (SSA) to conduct low-income subsidy eligibility redeterminations for recipients of the Medicare Prescription Drug Plan (Part D) subsidy. SSA needs forms to collect information from subsidy recipients so it can 1) determine if a subsidy redetermination is needed and 2) conduct the actual redetermination. The agency uses forms SSA-1026-REDE and SSA-1026-SCE for those purposes.

This ICR is for revised versions of both redetermination forms SSA will use to ensure compliance with Public Law 110-275, the Medicare Improvements for Patients and Providers Act of 2008. In the new versions, SSA will eliminate questions about the value of life insurance policies and in-kind support and maintenance. We will begin using form SSA-1026-REDE in September 2009, and form SSA-1026-SCE in December 2009.

The respondents are current recipients of the Medicare Part D low-income subsidy who will undergo an eligibility redetermination.

2. How, By Whom, and For What Purpose the Information Will be Used

Medicare Part D subsidy recipients undergo an eligibility redetermination under two potential circumstances. Below is a description of these scenarios and the appropriate form to use in each situation.

SSA-1026-REDE (Social Security Administration Review of Your Eligibility for Extra Help)

Form SSA-1026-REDE is a cyclical redetermination form SSA sends to certain Medicare Part D subsidy recipients whom the system automatically selects based on certain profile/selection criteria. Specifically, these are individuals who 1) became entitled to the Medicare Part D subsidy during the past 12 months, 2) were eligible for the Part D subsidy for more than 12 months, or 3) reported a change in income, resources, or household size (all factors which could affect subsidy amounts).

SSA-1026-SCE (Social Security Administration -- Reporting a Change That May Affect Your Extra Help)

SSA uses form SSA-1026-SCE to conduct subsidy eligibility redeterminations for Part D subsidy beneficiaries who report a potentially subsidy-changing event, including the following: 1) marriage, 2) spousal separation, 3) divorce, 4) annulment of a marriage, 5) spousal death, or 6) moving back in with your spouse following a separation. SSA sends the form to Medicare Part D subsidy recipients who have contacted SSA to self-report one of these events.

When sending out these forms, SSA includes a Resource and Income Summary form. This insert lists the subsidy eligible individual’s income and resource types and amounts and the household size. This information comes from 1) SSA’s records and 2) the information subsidy recipients provided on their original applications. The subsidy recipient who is undergoing a redetermination will refer to the Resource and Income Summary when completing the SSA-1026.

3. Use of Other Forms of Information Technology for this Information Collection

Due to the nature of these forms (i.e., SSA pre-fills certain information on them), the agency did not develop electronic versions under its Government Paperwork Elimination Act plan.

4. Describe Efforts to Identify Duplication

The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to obtain similar data.

5. Describe the Impact of the Information Collection on Small Businesses or Other Small Entities

This collection does not affect small businesses or other small entities.

6. Consequences of Not Conducting the Information Collection/Obstacles to Burden Reduction

If SSA did not conduct this information collection, we would have no means of conducting mandatory annual redeterminations, periodic subsidy eligibility redeterminations, or subsidy eligibility redeterminations for those reporting subsidy-changing events, which would be in violation of the relevant provisions of the MMA.

There are no technical or legal obstacles to burden reduction.

7. Explain Any Special Circumstances Relating to this Information Collection.

There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.

8. Publication of Federal Register Notices and Solicitation of Public Comment.

SSA published the advance 60-day Federal Register Notice on October 28, 2008, at 73 FR 64004, and we did not receive any public comments. We published the 30-day Federal Register Notice on December 29, 2008, at 73 79537. If we receive any public comments in response to the 30-day Notice, we will forward them to OMB.

SSA did not consult with the public in the development or maintenance of these forms.

9. Payment/Gifts to the Respondents

SSA provides no payment or gifts to the respondents.

10. Describe Assurance of Confidentiality to Respondents

SSA protects and holds confidential the information it is requesting 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. Justification for Questions of a Sensitive Nature

The information collection does not contain any questions of a sensitive nature.

12. Burden Estimates for the Information Collection.

Below we provide the estimated annual number of respondents, the average completion time, and the estimated annual burden for each form in the information collection.

Form	Number of Respondents	Average Burden Per Response (Completion time; expressed in minutes)	Estimated Annual Burden (expressed in hours)
SSA-1026-REDE	249,652	18	74,896
SSA-1026-SCE	11,984	18	3,595
Total	261,636	-	78,941 hours

The total annual burden of 78,941 represents burden hours, and we did not calculate a separate cost burden.

13. Cost to Respondents

There is no known cost burden to the respondents.

14. Federal Government Cost

The annual cost to the Federal Government is approximately $30,385. This estimate is a projection of the costs for printing and distributing the revised collection instruments and for collecting the information.

15. Change to Public Reporting Burden

The total annual burden for this collection decreased from 250,333 to 78,941 hours, representing a -171,392-hour decrease. This decrease is due to several factors: 1) the elimination of form SSA-L1026 (SSA Medicare Prescription Drug Assistance Notice of Review), which we no longer use; 2) the elimination of several questions from forms SSA-1026-REDE and SSA-1026-SCE, resulting in a 2-minute public response decrease (from 20 to 18 minutes); and 3) a reduction in the number of SSA-1026-SCE respondents (updated data indicated our original estimate was too high). Please see the Addendum to the Supporting Statement for further explanations of these changes.

16. Publication of the Results of the Information Collection

SSA will not publish the results of this information collection.

17. Displaying the OMB Expiration Date

OMB exempted SSA from the requirement to print the OMB approval date 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). OMB granted this exemption so that we would not have to destroy otherwise useable forms simply because of an expired OMB approval date, which also reduces Government waste.

18. OMB Certification Requirements

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).

2. Collections of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.

0960-0723 revisions (SSA-1026)

2/4/2021

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