Supporting Statement for Form SSA-8011-F3
Statement of Household Expenses and Contributions
20 CFR 416.1130–416.1148
OMB No. 0960-0456
1. Introduction/Authoring Laws and Regulations
The Social Security Administration (SSA) uses Form SSA-8011-F3 in the administration of the Supplemental Security Income (SSI) program. SSA bases eligibility for SSI on the needs of the recipients. Need is measured, in part, by the amount of income a recipient receives. Income includes in-kind support and maintenance in the form of food and shelter provided by other persons. Section 1612(a) (2) (A) of the Social Security Act (the Act) provides SSA will reduce the benefits of an eligible recipient who receives support and maintenance in kind by 33 and 1/3 percent. Section 1631(e) (1) (B) of the Act requires that independent or collateral sources verify the information used to determine eligibility for SSI benefits. 20 CFR 416.1130 – 416.1148 of the Code of Federal Regulations provides the procedures and policies for implementing Section 1612(a) (2)(A) of the Act.
Description of Collection
SSA uses the information on SSA-8011-F3 to ensure that a recipient is eligible to receive SSI payments and to determine the correct payment amount. The information permits SSA adjudicators to determine the income value, if any, of in-kind support and maintenance received by SSI claimants and recipients. The information collected on the SSA-8011-F3 is readily available to the respondents and requires no special recordkeeping. In addition, we do not use this form for all claims and post-eligibility determinations. SSA only uses form SSA-8011-F3 when it is necessary to document in-kind support and maintenance and only in cases where we need the householder’s corroboration. The respondent is the head of the household (householder) where an SSI applicant or recipient resides. Response to this collection is necessary to obtain or retain benefits.
Use of Information Technology to Collect the Information
SSA takes precautions to prevent misuse of form SSA-8011-F3. Unrestricted availability of this form on the Internet may permit usage of this form by people other than the appropriate person and could result in program abuse. For these reasons, SSA has determined that the SSA-8011-F3 is not an appropriate form for implementation on the Internet.
In 2009, SSA revised its procedures for completing Form SSA-8011-F3. The new procedure permits claims representatives to collect the information on form SSA-8011-F3 by telephone contact with the respondent, or face-to-face interviews. The claim representative records the information our electronic MSSICS system. When this procedure is used, a paper Form SSA-8011-F3 is not used, and we do not need a signature.
The paper SSA-8011-F3 provides information that could affect SSI eligibility and payment amount. Therefore, the appropriate person, i.e., the householder signs the form, the claim representative documents the information in MSSICS, faxes the form into the appropriate electronic folder, and the form is shredded.
In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Internet version of form SSA-8011. Based on our data, we estimate approximately 50% of respondents under this OMB number use the electronic version
4. Why We Cannot Use Duplicate Information
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.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
6. Consequence of Not Collecting Information or Collecting it Less Frequently Collection of the information takes place based on the need of the applicant to apply, or reaffirm eligibility, for SSI payments. Failure to obtain such information, when needed, would prevent SSA from making accurate determinations of eligibility and benefit amounts due, as required by law. Less frequent collection would create a high risk of incorrect SSI eligibility and payment determinations. SSA already limits use of the SSA-8011-F3 by targeting cases in which there is a greater probability of an incorrect determination. There are no technical or legal obstacles that prevent burden reduction.
Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
SSA published the 60-day advance Federal Register Notice published on October 06, 2009, at 74 FR 51353, and we received no public comments. The second Notice published on December 08, 2009, at 74 FR 64801. We did not consult with the public in the revision/maintenance of this form.
9. Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
10. Assurances of Confidentiality
SSA protects and holds confidential the information it collects 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.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Approximately 400,000 respondents take 15 minutes each to complete
form SSA-8011-F3 each year. Accordingly, the burden is 100,000
hours. This figure represents burden hours, and we did not calculate
a separate cost burden.
Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden to the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $1,960,380.00. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
15. Program Changes or Adjustments to the Information Collection Request
There are no changes in the public reporting burden.
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provision at 5 CFR 1320.8(b)(3).
B. Collection of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/msword |
| File Title | Supporting Statement for Form SSA-8011-F3 |
| Author | OPB |
| Last Modified By | Davidson, Liz |
| File Modified | 2009-12-17 |
| File Created | 2009-12-17 |