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

Forms and Documents

Document Name	Status
Form SSA-2930(revised) SSA-2930 Form	Modified
Form SSA-8510 SSA-8510 Form	New
Form SSA-820-F4 SSA-820 and SSA-821 Form	New
Form SSA-2935 SSA-2935 Form and Instruction	Modified
Form SSA-85 SSA-85 Form	Modified
Form SSA-8552 SSA-8552 Form	Modified
Form SSA-4659 SSA-4659 Form	Modified
Form SSA-2932 (revised) SSA-2932 Form	Modified
Form SSA-2931(revised) SSA-2931 Form	Modified
supporting statement 0189 (Revised).docx Supporting Statement A	2011-03-24
Supporting Statement Part B.docx Supporting Statement B	2011-03-16
Addendum - 0189.docx Supplementary Document	2011-03-17

IC Document Collections

IC ID	Document Title	Status
9153	SSA-2930 Form	Modified
195245	SSA-8510 Form	New
195231	SSA-820 and SSA-821 Form	New
190343	iClaim Stewardship Questions Other-follow-up stewardship questions	Unchanged
183776	SSA-2935 Form and Instruction	Modified
183775	SSA-85 Form	Modified
183774	SSA-8552 Form	Modified
183773	SSA-L8554-U3 Other-Notice	Modified
183772	SSA-L8553-U3 Other-Notice	Modified
183771	SSA-L8552-U3 Other-Notice	Modified
183770	SSA-L8551-U3 Other-Notice	Modified
183769	SSA-L8550-U3 Other-Notice	Modified
183268	SSA-4659 Form	Modified
183266	SSA-2932 Form	Modified
183264	SSA-2931 Form	Modified

ICR Details

OMB Control No: 0960-0189	ICR Reference No: 201011-0960-005
Status: Historical Active	Previous ICR Reference No: 201005-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/08/2011
	Date Received in OIRA: 03/24/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	36 Months From Approved	06/30/2011
Responses	18,424	0	13,499
Time Burden (Hours)	2,619	0	2,268
Cost Burden (Dollars)	0	0	0

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Abstract: SSA collects information on Forms SSA-2930, SSA-2931, and SSA-2932 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 (RSI) and Disability Insurance (DI) programs. SSA also uses the information to measure the accuracy rate for newly adjudicated RSI/DI cases. SSA collects information on Form SSA-4659 to evaluate and determine the effectiveness of the annual earnings test, and uses the results in developing ongoing improvements in the process. SSA sends each beneficiary an appointment letter for the interview. About 25 percent of respondents will have face-to-face contact reviews and receive one of the following letters for an appointment: SSA-L8550-U3 (Appointment Letter- Sample Individual), SSA-L8551-U3 (Appointment Letter- Sample Family), or the SSA-L8552-U3 (Appointment Letter-Rep Payee). The other 75 percent of respondents will receive a notice for a telephone contact review: either the SSA-L8553-U3 (Beneficiary Telephone Contact), or the SSA-L8554-U3 (Rep Payee Telephone Contact) notice. To help the beneficiary prepare for the interview, we include three forms with each notice: 1) SSA-85 (Information Needed to Review Your Social Security Claim) that lists the information the respondents will need to gather to prepare for the interview. 2) SSA-2935 (Authorization to the Social Security Administration to Obtain Personal Information) so SSA can obtain information to verify the correctness of the payment to the beneficiary. 3) SSA-8552 (Interview Confirmation) to confirm or reschedule the interview if necessary. The respondents are a statistically valid sample of all RSI/DI beneficiaries in current pay status or their representative payees. The respondents are a statistically valid sample of all RSI/DI beneficiaries in current pay status or their representative payees.

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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:
	75 FR 80563	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 14441	03/16/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

IC Title	Form No.	Form Name
SSA-2930	SSA-2930(revised)	RSI/DI Quality Review Case Analysis - Sampled Number Holder
SSA-2931	SSA-2931(revised)	RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors
SSA-2932	SSA-2932 (revised)	RSI/DI Quality Review Case Analysis ? Parent
SSA-4659	SSA-4659	Stewardship Annual Earnings Test Workbook
SSA-2935	SSA-2935	Authorization to the Social Security Administration to Obtain Personal Informaition
SSA-L8550-U3
iClaim Stewardship Questions
SSA-L8551-U3
SSA-L8553-U3
SSA-L8554-U3
SSA-L8552-U3
SSA-8552	SSA-8552	Interview Confirmation
SSA-85	SSA-85	Information Needed to Review Your Social Security Claim
SSA-8510	SSA-8510	Authorization For The Social Security Administration To Obtain Personal Information
SSA-820 and SSA-821	SSA-820-F4, SSA-821-BK	Work Activity Report (Self-Employed Person) ,   Work Activity Report-Employee

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ICR Summary 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	18,424	13,499	0	1,220	3,705	0
Annual Time Burden (Hours)	2,619	2,268	0	169	182	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: There is an increase in burden for this ICR, because we have begun using other forms as part of our quality reviews. Although these we clear these forms under separate OMB numbers, the burden we report here is only for their use in this ICR. The burden chart in question #12 indicates these forms and their OMB numbers.

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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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 03/24/2011

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