National Beneficiary Survey -- Ticket Participant Sample

OMB No. 0960-0666

ADVANCE LETTER

Para información y instrucciones en Español, llame 1-877-293-5740 por favor.

Date

NAME

ADDRESS 1

ADDRESS 2

ADDRESS 3

CITY, STATE ZIP

Dear (NAME):

I am writing to ask for your help with an important study sponsored by the Social Security Administration, The National Beneficiary Survey. The purpose of this study is to collect information about the health and well-being of people receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Results from the study will help the Social Security Administration evaluate how well its programs are meeting the needs of disability beneficiaries like yourself.

We have hired Mathematica Policy Research, a national research firm, to conduct the study. We assure you that all information collected will be kept strictly confidential and will not be reported in any way that identifies you personally. Further, the information collected will not be used by the Social Security Administration to determine your continuing eligibility for disability benefits. We are collecting this information for research purposes only.

You have been randomly selected to participate in this study. In about one week, an interviewer from Mathematica will call you by telephone to conduct an interview. While your cooperation is voluntary, the information you provide will be very important to the Social Security Administration and will contribute to improved government services for disability beneficiaries.

Your participation is important to us. If you need special assistance or wish to set up a time to be interviewed, please call our help desk (toll-free) at 1-877-293-5740 or send an email to [email protected]. Our TTY number is 1-877-293-5741. As a token of our appreciation, Mathematica will send you a check for $10 after you complete the interview.

To learn more about this study, please see the enclosed answers to frequently asked questions or log onto www.ssa.gov/work/survey.html.

Thank you very much for your assistance. We look forward to your participation.

Sincerely,

Pamela Mazerski

Associate Commissioner

Office of Program Development and Research

Office of Disability and Income Security Programs

Privacy Act Statement

This study was requested by the Social Security Administration (SSA) and is authorized by Congress under Public Law 106-170 section 101 (1)(d)(4)(C)(i). While your participation is voluntary, the information you provide is important for evaluating the effectiveness of SSA programs designed to help disability beneficiaries.

All information you provide will be kept strictly confidential and used by SSA for research purposes only. Your personal information may be used to match our records with records of other Federal, State, or local government records, but will not be stored with any answers you provide. No identifying information will be published or released to anyone, except as may be required by law, regulation, or subpoena. If you want to learn more about this, contact any Social Security office.

Paperwork Reduction Act Statement:

This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995.  You do not need to answer these questions unless we display a valid Office of Management and Budget control number.  We estimate that it will take about 45-55 minutes to read the instructions, gather the facts, and answer the questions.  Send only comments relating to our time estimate above to:  SSA, 6401 Security Blvd, Baltimore, MD  21235-6401.