Supporting Statement 0454 (revised)

Supporting Statement for Form SSA-L5061

Letter to Landlord Requesting Rental Information

20 CFR 416.1130(b)

OMB No. 0960-0454

A. Justification

1. Introduction/Authoring Laws and Regulations
Section 1612(a) (2)(A) of the Social Security Act (the Act) provides that the Social Security Administration (SSA) will reduce Supplemental Security Income (SSI) benefits of an eligible individual who receives in-kind support and maintenance (unearned income in the form of food or shelter that the respondent receives from someone else).

Section 1631(e)(1)(B) of the Act further requires that the Social Security Administration (SSA) verify information they use to determine eligibility for SSI benefits by independent or collateral sources. Part 20 CFR 416.1130(b) of the Code of Federal Regulations describes the circumstances under which SSA may consider in-kind support and maintenance from a rental subsidy.

2. Description of Collection
SSA uses the information from Form SSA-L5061 to identify rental subsidy arrangements involving applicants for and recipients of Supplemental Security Income (SSI) payments. SSA uses the information to determine an income value for these subsidies, eligibility for payments, and the correct amount payable. The

respondents are landlords of the SSI claimants.

SSA determines if the SSI recipient needs to complete Form SSA-L5061 during the initial claim process, or when the recipient is moving into a rental subsidy situation. SSA claims representatives contact the respondents for an interview via the telephone or a face-to-face interview. The claims representative records the rental subsidy information on our electronic MSSICS system. If the claim representative is unable to contact the respondent via the telephone or face-to face, we print and mail a paper form to the respondent for completion. The respondent completes, signs, and returns the form to the claim representative. Upon receipt, the claims representative documents the information in MSSICS or, for non-MSSICS cases, faxes the form into the appropriate electronic folder, and shreds the form.

3. Use of Information Technology to Collect the Information
In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Internet version of form SSA-L5061. Based on our data, we estimate approximately 95% 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.

5. Minimizing Burden on Small Respondents
   This collection does not affect small businesses or other small entities.

5. Consequence of Not Collecting Information or Collecting it Less Frequently
   If we did not use form SSA-L5061 we would have no way to make accurate determinations of eligibility and benefit amounts. Because we collect the information on an as needed basis, we cannot collect it less frequently.

There are no technical or legal obstacles to 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
The 60-day advance Federal Register Notice published on May 26, 2011 at 76 FR 30749, and we received no public comments. The 30-day FRN published on August 8, 2011 at 76 FR 48200. If we receive any comments in response to this Notice, we will forward them to OMB.

We did not consult with the public in the revision 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

Type of Request	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Estimated Annual Burden Hours (hours)
SSA-L5061(electronic)	50464	1	10	8411
SSA-L5061 (paper)	536	1	10	89
Total	5100	-	-	8500

This figure represents burden hours and we did not calculate a separate cost burden.

13. Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.

14. Annual Cost to Federal Government
The estimated cost to the Federal Government to collect the information is negligible. Because the cost of maintaining the system which collects this information is accounted for within the cost of maintaining all of SSA’s automated systems, it is not possible to calculate the cost associated with just one Internet application.

15. Program Changes or Adjustments to the Information Collection Request
There has been an increase in burden hours. The change stems from the increase in people applying for Supplemental Security Income.

16. Plans for Publication Information Collection Results
    SSA will not publish the results of the information collection.

17. 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.

18. Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

B. Collections of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.