Supporting Statement 0742 revised

Supporting Statement for the SSA-371

Request for Reinstatement (Title II)

20 CFR 404.1592b-404.1592f

OMB #0960-0742

1. Justification

1. Introduction/Authorizing Laws and Regulations

Section 112 of Public Law 106-170, the Ticket to Work and Work Incentives Improvement Act of 1999 added Section 223(i) to the Social Security Act (the Act) to allow certain previously entitled persons to request expedited reinstatement (EXR) of those disability benefits under Title II of the Act when their medical condition no longer permits them to perform substantial gainful activity (SGA). The rules for EXR as codified by 20 CFR 404.1592b through 20 CFR 404.1592f in the Code of Federal Regulations.

2. Description of Collection

The Social Security Administration (SSA) uses the information collected from form SSA-371 to inform previously entitled persons of the EXR requirements and to document the request for EXR. An SSA Claims Representative gives the form to the person, or mails it to the person if he or she requests EXR over the phone. Because the EXR process is a paper process, we maintain the signed form in the paper disability folder as documentation that the person is aware of the EXR requirements and is requesting EXR. There is no copy of the form saved in the electronic disability folder at this time. The respondents are applicants for expedited reinstatement of Title II disability benefits.

3. Use of Information Technology to Collect the Information

An electronic version is not available due to the low number of respondents.

SSA did not create an electronic version of this form under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 10,000 respondents complete the form. This is less than the GPEA cut-off of 50,000.

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.

5. Minimizing Burden on Small Respondents

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

6. Consequence of Not Collecting Information or Collecting it Less Frequently

If SSA did not collect this information, the agency could not ensure that persons who are requesting EXR are aware of the requirements and that they have made the choice to request EXR. In addition, since SSA collects this information on an as needed basis, we cannot collect the information less frequently. There are no technical or legal obstacles that prevent burden reduction.

7. Special Circumstances

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

8. 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

11. Justification for Sensitive Questions

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

12. Estimates of Public Reporting Burden

Approximately 10,000 respondents take 2 minutes each to complete form SSA-371 each year. Accordingly, the burden is 333 burden hours. Respondents only need to complete the form once. This figure represents burden hours, and we did not calculate a separate cost burden.

13. Annual Cost to the Respondents (Others)

This collection does not impose a known cost burden to the respondents.

14. Annual Cost to Federal Government

The annual cost to the Federal Government is $46,200. 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 to the public reporting burden.

16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

17. Displaying 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.

18. Exceptions to Certification Statement

SSA is not requesting an exception to the certification requirements at 5 CFR 1 320.9 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.