Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Sewardship Annual Earnings Test Workbook

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-2930 RSI/DI Quality Review Case Analysis - Sampled Number Holder	Form	Modified	Available
Form SSA-2935 Authorization to the Social Security Administration to Obtain Personal Informaition	Form and Instruction	Unchanged	Available
Form SSA-85 Information Needed to Review Your Social Security Claim	Form	Unchanged	Repair queued
Form SSA-8552 Interview Confirmation	Form	Unchanged	Repair queued
Form SSA-4659 Stewardship Annual Earnings Test Workbook	Form	Unchanged	Repair queued
Form SSA-2932 RSI/DI Quality Review Case Analysis � Parent	Form	Unchanged	Available
Form SSA-2931 RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors	Form	Unchanged	Available
0960-0189 non-substantive change.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-04-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9153	SSA-2930	Form	Modified	RSI/DI Quality Review Case Analysis - Sampled Number Holder
183776	SSA-2935	Form and Instruction	Unchanged	Authorization to the Social Security Administration to Obtain Personal Informaition
183775	SSA-85	Form	Unchanged	Information Needed to Review Your Social Security Claim
183774	SSA-8552	Form	Unchanged	Interview Confirmation
183773	SSA-L8554-U3	Other-Notice	Unchanged
183772	SSA-L8553-U3	Other-Notice	Unchanged
183771	SSA-L8552-U3	Other-Notice	Unchanged
183770	SSA-L8551-U3	Other-Notice	Unchanged
183769	SSA-L8550-U3	Other-Notice	Unchanged
183268	SSA-4659	Form	Unchanged	Stewardship Annual Earnings Test Workbook
183266	SSA-2932	Form	Unchanged	RSI/DI Quality Review Case Analysis � Parent
183264	SSA-2931	Form	Unchanged	RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors

ICR Details

OMB Control No: 0960-0189	ICR Reference No: 200904-0960-006
Status: Historical Active	Previous ICR Reference No: 200801-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Sewardship Annual Earnings Test Workbook
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: 04/20/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/20/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2011	05/31/2011	05/31/2011
Responses	12,375	0	12,075
Time Burden (Hours)	2,147	0	1,997
Cost Burden (Dollars)	0	0	0

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Abstract: The information on Forms SSA–2930, SSA–2931 and SSA–2932 is used by the SSA to establish a national payment accuracy rate for all cases in payment status and to serve as a source of information regarding problem areas in the Retirement and Survivors Insurance (RI) and Disability Insurance (DIY) programs. The information is also used to measure the accuracy rate for newly adjudicated RI/DIY cases. SSA uses the information on form SSA–4659 to evaluate and determine the effectiveness of the annual earnings test and to use the results in developing ongoing improvements in the process. The respondents are a statistically valid sample of all RI/DIY beneficiaries in current pay status. In this "change sheet," we are increasing the number of respondents for form SSA-2930 by 300.

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Authorizing Statute(s): US Code: 42 USC 1382c Name of Law: Social Security Act
   US Code: 42 USC 1395o Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 428 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 62510	11/05/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 10505	02/27/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
SSA-2930	SSA-2930	RSI/DI Quality Review Case Analysis - Sampled Number Holder
SSA-2931	SSA-2931	RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors
SSA-2932	SSA-2932	RSI/DI Quality Review Case Analysis � Parent
SSA-2935	SSA-2935	Authorization to the Social Security Administration to Obtain Personal Informaition
SSA-4659	SSA-4659	Stewardship Annual Earnings Test Workbook
SSA-85	SSA-85	Information Needed to Review Your Social Security Claim
SSA-8552	SSA-8552	Interview Confirmation
SSA-L8550-U3
SSA-L8551-U3
SSA-L8552-U3
SSA-L8553-U3
SSA-L8554-U3

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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	12,375	12,075	0	300	0	0
Annual Time Burden (Hours)	2,147	1,997	0	150	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: SSA plans to conduct a Quality Review with 300 respondents who submitted an iClaim application (OMB No. 0960-0618). Therefore, the burden for form SSA-2930 has increased.

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Annual Cost to Federal Government: $3,317

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)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 04/20/2009

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