Addendum to the Supporting Statement for Social Security Benefits Application:
Form SSA-1: Application for Retirement Insurance Benefits
Form SSA-2: Application for Wife’s or Husband’s Insurance Benefits
Form SSA-16: Application for Disability Insurance Benefits
Internet Claim (iClaim) Application Screens
20 CFR 404.310-404.311, 404.315-404.322, 404.330-404.333, 404.601-404.603, and 404.1501-404.1512
OMB No. 0960-0618
Revisions to the Collection Instruments:
Changes to iClaim
This addendum summarizes the enhanced changes to the iClaim functionality. The attached iClaim screen shots file reflects these changes. Additionally, it shows the new iAppointment application functionalities.
While there are more screens in the actual iClaim application path, we ask the same questions as for the MCS version. We are making changes to related screens to accommodate the new functionalities, clarify some existing screens, and incorporate the iAppointment application. The new screens and changes include:
Collection paths to obtain foreign residence and mailing address
We will present Medicaid information and Group Health Plan questions currently available for Medicare-Only to retirement and Medicare age disability applicants
A new functionality to allow applicants to cancel appointments
The iAppointment application
Below is a summary of changes and additions for all the iClaim screens included in this Information Collection Request:
Foreign Residence and mailing Information – We removed the sub-title header “U.S Mailing Address.” We added a country selection drop down to give the option to enter a foreign country (barred and restricted countries will not be included in the drop down). “United States of America” will be the default for the drop down. (Modified Screens #1, pg. 6)
Prior Marriage Screens – The iClaim application currently collects material marriage history by asking claimants for their current and prior marriage information. We define a material marriage as: a) a current marriage; b) a marriage that lasted 10 or more years but ended in divorce; c) a marriage that ended in death. However, the marriage question in the iClaim application does not ask for impediment marriage information (e.g., the last marriage of any duration for a divorced spouse claimant). (See modified screen #2, p.2).
When to Start Benefits section – For applicants who may be of retirement age but also allege a disability this page may be confusing, as the page is specific to retirement benefits only. Therefore, to clarify, we are updating the header and first sentence on the page to reference “retirement.” (Modified screen #2)
Medicare-Only Screens – In March 2010, we added the Medicare-Only Application to iClaim. Some of the questions we ask in that application also relate to retirement and disability applications. Therefore, we will incorporate these existing screens into the retirement and disability paths:
Health Insurance Information Screen – We will incorporate the following questions from this screen into the retirement and disability paths (Retirement and Disability Path Existing Screen (Medicare-Only) #1, p.4):
Do you want to enroll in Medicare Part B?
Are you receiving Medicaid (state health insurance)?
Medicaid Information Screen – The system generates a conditional screen if the answer to the Medicaid question on the Health Insurance screen (see above) is “yes.” The generated screen asks other questions related to Medicaid (i.e., Medicaid start and end dates; Medicaid number, and Medicaid state). (Retirement and Disability Path Existing Screen (Medicare-Only) #2, p.5)
Group Health Plan Information – The system presents questions regarding group health plan coverage. If the response is “yes” to coverage under a group health plan, the system generates the next question, “Are you covered through your own employment?” If the respondent answers “no,” then the system asks, “Are you covered through another person’s employment?” However, if the respondent answers “yes” to the coverage question, the system asks questions regarding employment and health insurance coverage (e.g., “start date,” and “stop date”). (Retirement and Disability Path Existing Screen (Medicare-Only) #3, p.6).
Appointment Cancellation Screen – This screen will allow applicants who completed the iClaim application to cancel an initial claim appointment that they scheduled through an SSA representative. (iClaim New Screen #1, p.7).
Addition of the iAppointment Application
Explanation of iAppointment and Why SSA is Adding it
The White House CIO, Vivek Kundra, charged SSA with developing an online process that would enable users to schedule an appointment with a field office.
For the initial release, the purpose of the iAppointment application is to provide members of the public, who are unable to complete an iClaim application because they failed our initial verification checks, an easy-to-use method to schedule an appointment in the servicing office of their choice. The initial verification check failures that preclude an applicant from completing iClaim include, but are not limited to, the following:
The user enters a date of birth (DOB) which fails to match the DOB associated with the Social Security Number (SSN) the user entered
There is a Death indicator associated with the SSN entered
There is a False Identity indicator associated with the SSN entered
SSA expects iAppointment will reduce calls to SSA’s National 800 Number by allowing self-service scheduling of appointments for users who are unable to take advantage of iClaim.
How iAppointment Will Benefit the Public
The iAppointment application will provide an easy-to-use method to schedule an appointment online for customers who want to conduct business with SSA via telephone or in person by visiting one of our field offices.
iAppointment will allow customers to establish a protective filing date for their application. Since the date they file can affect their benefits, the iAppointment application will provide them information related to the date by which they must file their application.
iAppointment is a customer-centric application. If the available appointment times do not meet the customer’s needs, iAppointment will allow them to enter a different zip code to identify another field office, which may offer different appointment times.
How iAppointment Works
Users unable to complete an iClaim application because they failed the initial verification checks will receive a message page that will include the link to the iAppointment application.
The system will only display this option to applicants who entered iClaim by selecting the radio button “I am applying for myself,” or “I am helping someone who wants to apply for benefits and is with me.”
If the users indicate they are filing as a third party (attorney, representative payee, etc.), iClaim will provide a message page directing them to call the National 800 Number for assistance.
For the initial release, data propagated from iClaim will be the individual’s SSN, name, DOB, and gender information. The applicants will not be able to change the SSN, however, they will have the opportunity to rekey their name, DOB, and gender information. In addition, the system will ask users to provide their mailing address and telephone number.
If the users live outside the United States, the system will generate a message page indicating that they will need to contact a Social Security representative, and will provide an accompanying link to our Service Around the World website.
The system will ask users residing in the United States to supply their language preference.
The appointment types iAppointment will make available to them are the types of claims they can file on iClaim: Disability, Retirement, and Medicare.
If users request to apply for Disability benefits, the system will ask them to provide their disability onset date. iAppointment will also ask them if they intend to file for Supplemental Security Income (SSI) benefits.
Note: the system will also ask individuals whose alleged DOB shows they are within at least 2 months before age 65, or later in the filing month for Title II benefits, if they intend to file for SSI.
The Appointment Details page will allow all users to select a telephone or in-office appointment. It will also allow them to supply an email address if they would like us to send them an email confirmation.
The Appointment Date & Time page will present users with a calendar displaying the next 20 workdays from which to choose an appointment time. If the available appointment times do not meet the customers’ needs, the system will allow them to enter a different zip code to indentify another field office, which may offer different appointment times.
The Verify Selection page will present the details of the appointment, allowing the user to complete the scheduling process.
The Confirmation page will give the users details of their scheduled appointment.
Revisions to the Paper forms: SSA-1, SSA-1-INST, SSA-2, SSA-2-INST, SSA-16, and SSA‑16-INST
Revisions to the SSA-1
Page #1:
In question #6, we added part C to ask the claimant the date on which the U.S. lawfully admitted them.
We are changing this question to make the paper form more like the questions in MCS.
We are adding instruction in the answer section for part B to indicate whether the respondent should continue to question #7 or to the new part C.
On page #2:
We deleted the instruction between questions #11 and #12:
We are deleting the statement because question #12 asks the claimant to provide a “Yes” or “No” answer regarding military service. This makes the statement above the question unnecessary.
In question #15, we are adding the following statement:
I agree to promptly notify the Social Security Administration if I become entitled to a pension or annuity based on my employment not covered by Social Security, or if such pension or annuity stops.
We are adding this statement to prompt the Claims Representative to remind the claimant about their reporting responsibilities regarding receiving such payments.
Page #3:
We are entirely revamping question #17:
We are changing this question to reflect changes in policy. SSA streamline the marriage documentation policy for title II claims to ask only for those marriages that could create entitlement or cause a material discrepancy.
We are adding the following statement at the bottom of the question:
“If your claim for retirement benefits is approved, your children (including adopted children, and stepchildren) or dependent grandchildren (including step-grandchildren) may be eligible for benefits based on your earnings record.”
We are adding this statement to prompt the Claims Representative to explain to the applicant the possibility of the number holder’s children’s eligibility to benefits, and as a lead in to ask question #18.
We modified or deleted some language in question #18:
We removed the term “natural children” because we do not use it in the regulations
We modified the second bullet to read, “Age 18 to 19 and attending elementary or secondary school full-time,” to reflect the policy requirement of full time attendance.
We deleted the last paragraph in this section as it referred to a no longer applicable time period.
Page #5:
We deleted the instructions between questions #26 and #27 due to changes to question #27.
We reworded the month of election options in question #27 to comply with the Financial Literacy policy.
We fully modified the section titled “Medicare Information.”
We are making this change at the request of the Office of Enumeration and Medicare Policy. The new language simplifies the Medicare information and provides the new premium information based on IRS reported income. We also added information about Medicare prescription drug plan (Part D), and Medicare contact information.
The section was changed:
From:
“If
this claim is approved and you are still entitled to benefits at age
65, you will automatically receive Medicare Part A (Hospital
Insurance) and Medicare Part B (Medical Insurance) coverage
at age 65. If you are not eligible for automatic enrollment in
Medicare Part B, this application may be used for voluntary
enrollment.
COMPLETE ITEM 28 ONLY IF YOU ARE WITHIN 3 MONTHS OF AGE 65 OR OLDER
In most cases, Medicare does not pay for health care you get while traveling outside the United States. Your local Social Security office will be glad to explain more about Medicare. Enrollment in Medicare Part B (Medical Insurance): Medicare Part B helps cover doctor's services and outpatient care. It also covers some other services that Medicare Part A doesn't cover. Once you are enrolled in Medicare Part B, you will have to pay a monthly premium. The date your Medicare Part B begins and the amount of the premium you must pay depends on the month you filed this application with the Social Security Administration. Your premiums will be deducted from any monthly Social Security, Railroad Retirement, or Office of Personnel Management benefit check you receive. If you do not receive such benefits, you will be notified how to pay your premiums. You will get advance notice if there is any change in your premium amount. If you do not enroll in Medicare Part B now, you can enroll later only during a specified enrollment period. If you enroll later, your coverage may be delayed and you may have to pay a higher premium”
To:
“If this claim is approved and you are still entitled to benefits at age 65, or you are within 3 months of age 65 or older, you could automatically receive Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage at age 65. If you are not eligible for automatic enrollment in Medicare Part B, you will need to contact Social Security to request enrollment.
COMPLETE ITEM 28 ONLY IF YOU ARE WITHIN 3 MONTHS OF AGE 65 OR OLDER
Medicare Part B (Medical Insurance) helps cover doctor's services and outpatient care. It also covers some other services that Medicare Part A doesn't cover, such as some of the services of physical and occupational therapists and some home health care. If you enroll in Medicare Part B, you will have to pay a monthly premium. The amount of your premium will be determined when your coverage begins. In some cases, your premium may be higher based on information about your income we receive from the Internal Revenue Service. Your premiums will be deducted from any monthly Social Security, Railroad Retirement, or Office of Personnel Management benefits you receive. If you do not receive any of these benefits, you will get a letter explaining how to pay your premiums. You will also get a letter if there is any change in the amount of your premium.
You can also enroll in a Medicare prescription drug plan (Part D). To learn more about Medicare prescription drug plans and when you can enroll, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Medicare also can tell you about agencies in your area that can help you choose your prescription drug coverage.
If you have limited income and resources, we encourage you to apply for the Extra Help that is available to assist you with Medicare prescription drug costs. The Extra Help can pay the monthly premiums, annual deductibles and prescription co-payments. To learn more or apply, please visit www.socialsecurity.gov, call 1-800-772-1213 (TTY 1-800-325-0778) or visit the nearest Social Security office”
We deleted questions #30 and #31 to reflect policy changes.
Effective September 27, 2008, SSA no longer asks Title II Social Security applicants about his or her felony or probation/parole violator status on any of the Title II benefit applications.
Page #7:
We are updating the Privacy Act Notice language with the latest version from the Office of General Counsel.
We are updating the Paperwork Reduction Act Statement to include the TTY telephone number and website in order to provide better public service.
Page #8:
We modified the “Changes to be reported and how to report” section
We removed “after 1956” from the last bullet from the left column, since it refers to a time period no longer applicable to claimants presently filing for benefits.
We added a bullet to the right column with the following information:
If you become the parent of a child (including an adopted child) after you have filed your claim, let us know about the child so we can decide if the child is eligible for benefits. Failure to report the existence of these children may result in the loss of possible benefits to the child(ren).
We are adding this information to inform the claimants about the current policy of reporting becoming a parent.
We updated the “How to Report” section in the right column to show the SSA website in order to show that respondents can make post-entitlement reports or changes via the SSA’s website.
We modified the section “Please read the following information carefully before you answer question 22” to read:
“If you are under full retirement age, retirement benefits cannot be paid for any month before the month in which you file your claim.
If you are full retirement age or older, retirement benefits may be payable for some months before the month in which you file this claim, but not before the month you attain full retirement age.”
We made this modification to provide better understanding to the respondents.
Revision to the SSA-1-INST, Reporting Responsibilities for Retirement Insurance Benefits
Page #1:
We corrected the OMB Control Number so it reads 0960-0618.
We modified the section “Changes to be reported and how to report”
We removed “after 1956” from the 7th bullet from the left column, since it refers to a time period no longer applicable to claimants presently filing for benefits.
Added a bullet to the right column with the following information:
If you become the parent of a child (including an adopted child) after you have filed your claim, let us know about the child so we can decide if the child is eligible for benefits. Failure to report the existence of these children may result in the loss of possible benefits to the child(ren).
We are adding this information to inform the claimants about the current policy of reporting becoming a parent.
We updated the “How to Report” section in the right column to show the SSA website.
We added this information to show that respondents can make post-entitlement reports or changes on SSA’s website.
The section “Notice About Documents” (bottom of page #1) we added the phrase “a copy of” to the current statement.
We added the phrase to advise claimants that they should retain a copy of the original documents provided to us.
Page #2:
We corrected the OMB Control Number so it reads 0960-0618.
We updated the Privacy Act Notice with the latest notice from the Office of General Counsel.
We added the TTY telephone number and website to the last paragraph of the Paperwork Reduction Act statement to provide better public service.
Revision to the SSA-2
Page #1:
We added part C to question #7 to ask the claimant the date the U.S. lawfully admitted them.
We are changing this question to make the paper form more like the questions in MCS.
Page #2:
We deleted the instruction between questions #11 and #12 because question #12 asks the claimant to provide a “Yes” or “No” answer regarding military service. This makes the statement above the question unnecessary.
We added the following statement to the bottom of question #15 (b) to prompt the Claims Representative to remind the claimant about their reporting responsibilities regarding receiving such payments:
“I agree to promptly notify the Social Security Administration if I become entitled to a pension or annuity based on my employment not covered by Social Security, or if such pension or annuity stops.”
We entirely revamped Question #16 to reflect changes in policy.
We streamlined the marriage documentation policy for title II claims to only ask for those marriages that could create entitlement or cause a material discrepancy.
We removed the term “natural children” in question #17, because we do not use it in the regulations.
We removed the highlighting from the areas in question #18, from “Work Began” and “Work Ended,” because it serves no purpose.
Pages #4 & #5:
We reworded the month of election options in question #22 to comply with the Financial Literacy policy.
We fully modified the section titled “Medicare Information.”
We are making this change at the request of the Office of Enumeration and Medicare Policy.
The new language simplifies the Medicare information and provides the new premium information based on IRS reported income. We also added information about Medicare prescription drug plan (Part D) and Medicare contact information.
We made the following changes to the section:
From:
“If this claim is approved and you are still entitled to benefits at age 65, you will automatically receive Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage at age 65. If you are not eligible for automatic enrollment in Medicare Part B, this application may be used for voluntary enrollment.
COMPLETE ITEM 23 ONLY IF YOU ARE WITHIN 3 MONTHS OF AGE 65 OR OLDER
In most cases, Medicare does not pay for health care you get while traveling outside the United States. Your local Social Security office will be glad to explain more about Medicare. Enrollment in Medicare Part B (Medical Insurance): Medicare Part B helps cover doctor's services and outpatient care. It also covers some other services that Medicare Part A doesn't cover. Once you are enrolled in Medicare Part B, you will have to pay a monthly premium. The date your Medicare Part B begins and the amount of the premium you must pay depends on the month you filed this application with the Social Security Administration. Your premiums will be deducted from any monthly Social Security, Railroad Retirement, or Office of Personnel Management benefit check you receive. If you do not receive such benefits, you will be notified how to pay your premiums. You will get advance notice if there is any change in your premium amount. If you do not enroll in Medicare Part B now, you can enroll later only during a specified enrollment period. If you enroll later, your coverage may be delayed and you may have to pay a higher premium.”
To:
“If this claim is approved and you are still entitled to benefits at age 65, or you are within 3 months of age 65 or older you could automatically receive Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage at age 65. If you are not eligible for automatic enrollment in Medicare Part B, you will need to contact Social Security to request enrollment.
COMPLETE ITEM 23 ONLY IF YOU ARE WITHIN 3 MONTHS OF AGE 65 OR OLDER
Medicare Part B (Medical Insurance) helps cover doctor's services and outpatient care. It also covers some other services that Medicare Part A doesn't cover, such as some of the services of physical and occupational therapists and some home health care. If you enroll in Medicare Part B, you will have to pay a monthly premium. The amount of your premium will be determined when your coverage begins. In some cases, your premium may be higher based on information about your income we receive from the Internal Revenue Service. Your premiums will be deducted from any monthly Social Security, Railroad Retirement, or Office of Personnel Management benefits you receive. If you do not receive any of these benefits, you will get a letter explaining how to pay your premiums. You will also get a letter if there is any change in the amount of your premium.
You can also enroll in a Medicare prescription drug plan (Part D). To learn more about the Medicare prescription drug plans and when you can enroll visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) Medicare also can tell you about agencies in your area that can help you choose your prescription drug coverage.
If you have limited income and resources, we encourage you to apply for the Extra Help that is available to assist you with Medicare prescription drug costs. The Extra Help can pay the monthly premiums, annual deductibles and prescription co-payments. To learn more or apply, please visit www.socialsecurity.gov, call 1-800-772-1213 (TTY 1-800-325-0778) or visit the nearest Social Security office.”
We deleted questions #25 and #26 to reflect policy changes.
Effective September 27, 2008, SSA no longer asks Title II Social Security applicants about his or her felony or probation/parole violator status on any of the Title II benefit applications.
Page #7:
We updated the Privacy Act Notice with the latest notice from the Office of General Counsel.
We updated Paperwork Reduction Act statement by adding the TTY telephone number and SSA’s website to the last paragraph to provide better public service.
Page #8:
We modified the section “Changes to be reported and how to report.”
We added a bullet to the left column with the following information:
“If you become the parent of a child (including an adopted child) after you have filed your claim, let us know about the child so we can decide if the child is eligible for benefits. Failure to report the existence of these children may result in the loss of possible benefits to the child(ren).”
We are adding this information to inform the claimants about the current policy of reporting becoming a parent.
We modified the last bullet in the right column to read as follows:
“You become entitled to a pension or annuity based on your employment not covered by Social Security, or if such pension or annuity changes or stops.”
We modified the statement to provide a clear message.
We updated the “How to Report” section in the right column to show that respondents can make post-entitlement reports or changes on SSA’s website.
We modified the first paragraph of the section “Please read the following information carefully before you answer question 22,” to read as follows:
“If you are under full retirement age, wife’s or husband’s benefits cannot be paid for any month before the month in which you file your claim.
If you are full retirement age or older, wife’s or husband’s benefits may be payable for months before the month in which you file this claim, but not before the month you attain full retirement age.”
We modified the paragraph to provide a better understanding.
Revisions to the SSA-2-INST
Page #1:
We modified the “Changes to be reported and how to report” section
Added a bullet to the left column with the following information:
“If you become the parent of a child (including an adopted child) after you have filed your claim, let us know about the child so we can decide if the child is eligible for benefits. Failure to report the existence of these children may result in the loss of possible benefits to the child(ren).”
We are adding this information to inform the claimants about the current policy of reporting becoming a parent.
We modified the last bullet in the right column to read:
“You become entitled to a pension or annuity based on your employment not covered by Social Security, or if such pension or annuity changes or stops.”
We modified the statement to provide a clear message
We updated the “How to Report” section in the right column to show that respondents can make post-entitlement reports or changes on SSA’s website.
Page #2:
We added the phrase “a copy of” to the current statement in the “Notice About Documents” section.
We added the phrase to advise claimants that they should retain a copy of the original documents provided to us.
We updated the Privacy Act Notice with the latest notice from the Office of General Counsel.
We updated the Paperwork Reduction Act statement to add the TTY telephone number and SSA website to the last paragraph to provide better public service.
Revisions to the SSA-16
Page #1:
We corrected the OMB Control Number so it reads 0960-0618
In question #5, we corrected the capitalization of “speak” and “write” for format consistency.
In question #7, we added part C to ask the claimant the date the U.S. lawfully admitted them.
We are changing this question to make the paper form more like the questions in MCS.
Page #2:
We modified and/or deleted language from several questions
We deleted the instruction between question #11 and #12
We are deleting the statement because question #12 asks the claimant to provide a “Yes” or “No” answer regarding military service. This makes the statement above the question unnecessary.
We modified the statement between question #15(c) and #16 to delete “after 1956”since it refers to a time period no longer applicable to claimants presently filing for benefits.
We entirely revamped question #16 to reflect changes in policy.
SSA streamlined the marriage documentation policy for title II claims to only ask for those marriages that could create entitlement or cause a material discrepancy.
Pages #3 & #4:
In question #17, we removed the term “natural children” because we do not use it in the regulations
We deleted question #23 due to the increased efficiency of the posting of earnings.
We no longer require the field office to develop for lag earnings routinely.
We renumbered to reflect this change
We deleted questions #32 and #33 to reflect policy changes.
Effective September 27, 2008, SSA no longer asks Title II Social Security applicants about his or her felony or probation/parole violator status on any of the Title II benefit applications.
Page #6:
We updated the Privacy Act Notice (page 6) with the latest notice from the Office of General Counsel.
We added the TTY telephone number and the SSA website to the last paragraph of the Paperwork Reduction Act statement.
Page #7:
We modified the section “Changes to be reported and how to report.”
We removed “after 1956” from the 7th bullet in the left column since it refers to a time period no longer applicable to claimants presently filing for benefits.
We modified the last bullet in the right column to read:
“You are under age 65 and you apply for or begin to receive workers’ compensation (including black lung benefits) or another public disability benefit, or the amount of your present workers’ compensation or public disability benefit changes or stops, or you receive a lump-sum settlement.”
We changed this item to include claimants under age 65.
We updated the “How to Report” section in the right column to show that respondents can make post-entitlement reports or changes on SSA’s website.
Revisions to the SSA-16-INST
Page #1:
We modified the section “Changes to be reported and how to report”
We removed “after 1956” from the last bullet in the left column since it refers to a time period no longer applicable to claimants presently filing for benefits.
We added a closing parenthesis at the end of “self-employed” in the 3rd bullet of the right column to correct a typographical error.
We modified the 5th bullet in the right column to read:
“You are under age 65 and you apply for or begin to receive workers’ compensation (including black lung benefits) or another public disability benefit, or the amount of your present workers’ compensation or public disability benefit changes or stops, or you receive a lump-sum settlement.”
We changed this item to include claimants under age 65.
We updated the “How to Report” section to show that respondents can make post-entitlement reports or changes on the SSA’s website.
We added the phrase “a copy of” to the current statement in the “Notice About Documents” section (at the bottom of the page), to advise claimants that they should retain a copy of the original documents provided to us.
Page #2:
We updated the Privacy Act Notice with the latest notice from the Office of General Counsel.
We modified the Paperwork Reduction Act statement (page 2) to indicate a new method to locate the nearest field office, to show the TTY number, and to reword the last paragraph to read: “You may send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.”
We made these modifications to provide better public service.
Addendum to the Supporting Statement
| File Type | application/msword |
| File Title | Addendum to the Supporting Statement for Social Security Benefits Application |
| Author | 231030 |
| Last Modified By | 889123 |
| File Modified | 2010-08-18 |
| File Created | 2010-08-18 |