Supporting Statement for
Redetermination of Eligibility For
Extra Help With Medicare Prescription Drug Plan Costs
Forms SSA-1026-REDE (Social Security Administration Review of
Your Eligibility for Extra Help)
and
SSA-1026-SCE (Social Security Administration Reporting a
Change That May Affect Your Extra Help)
20 CFR 418.3125
OMB No. 0960-0723
Justification
Need for the Information Collection and Legal/Administrative Justification
Section 1860D-14(a)(3)(A)(iv)(I) of the Medicare Modernization Act of 2003, as codified in section 418.3125 of the Code of Federal Regulations, requires the Social Security Administration (SSA) to conduct low-income subsidy eligibility redeterminations for recipients of the Medicare Prescription Drug Plan (Part D) subsidy. SSA needs forms to collect information from subsidy recipients so we can 1) determine if a subsidy redetermination is necessary and 2) conduct the actual redetermination. The agency uses Forms SSA-1026-REDE and SSA-1026-SCE for those purposes.
The respondents are current recipients of the Medicare Part D low-income subsidy who will undergo an eligibility redetermination.
Description of Collection
Medicare Part D subsidy recipients undergo an eligibility redetermination under two potential circumstances. Below is a description of these scenarios and the appropriate form to use in each situation. This collection is mandatory for respondents who wish to continue their Medicare Part D subsidy. SSA employees collect this information.
SSA-1026-REDE (Social Security Administration Review of Your Eligibility for Extra Help)
Form SSA-1026-REDE is a cyclical redetermination form SSA sends to certain Medicare Part D subsidy recipients whom the system automatically selects based on certain profile/selection criteria. Specifically, these are individuals who 1) became entitled to the Medicare Part D subsidy during the past 12 months; 2) were eligible for the Part D subsidy for more than 12 months; or 3) reported a change in income, resources, or household size (all factors which could affect subsidy amounts).
SSA-1026-SCE (Social Security Administration -- Reporting a Change That May Affect Your Extra Help)
SSA uses form SSA-1026-SCE to conduct subsidy eligibility redeterminations for Part D subsidy beneficiaries who report a potentially subsidy-changing event, including the following: 1) marriage, 2) spousal separation, 3) divorce, 4) annulment of a marriage, 5) spousal death, or 6) moving back in with one’s spouse following a separation. SSA sends the form to Medicare Part D subsidy recipients who have contacted SSA to self-report one of these events.
When SSA mails these forms to recipients, SSA includes a Resource and Income Summary form. This insert lists the subsidy-eligible individual’s income and resource types, income and resources amounts, and the household size on record. This information comes from 1) SSA’s records, and 2) the information subsidy recipients provided on their original applications. The subsidy recipient undergoing a redetermination should refer to the Resource and Income Summary when completing the SSA-1026.
Use of Information Technology to Collect the Information
Due to the nature of these forms (i.e., SSA pre-fills certain information on them), the agency did not develop electronic versions under its Government Paperwork Elimination Act plan.
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.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
Consequence of Not Conducting Information or Collecting it Less Frequently
If SSA did not conduct this information collection, we would have no means of conducting mandatory annual redeterminations, periodic subsidy eligibility redeterminations, or subsidy eligibility redeterminations for those reporting subsidy-changing events, which would be in violation of the relevant provisions of the MMA.
If we conducted the information collection less frequently, we would risk providing subsidies to individuals who are not eligible due to changes in resources, income, or living arrangements.
There are no technical or legal obstacles to burden reduction.
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.
Solicitation of Public Comment or Other Consultations with the Public- SSA published the 60-day advance Federal Register Notice on September 23, 2011, at 76 FR 59180, and there were no public comments. We published the 30-day Federal Register Notice on December 15, 2011, at 76 FR 78068. If we receive any public comments, we will forward them to OMB. There have been no consultations with members of the public. We did not consult with the public in the maintenance of these forms.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it is requesting 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.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Below we provide the estimated annual number of respondents, the average completion time, and the estimated annual burden for each form in the information collection.
Form |
Number of Respondents |
Frequency of Response |
Average Burden per Response (minutes) |
Estimated Total Annual Burden (hours) |
SSA-1026-REDE |
225,000 |
1 |
18 |
67,500 |
SSA-1026-SCE |
11,400 |
1 |
18 |
3,420 |
Total |
236,400 |
- |
- |
70,920 |
The total annual burden of 70,920 represents burden hours, and we did not calculate a separate cost burden.
Cost to Respondents
This collection does not impose a known cost burden on the respondents.
Annual Cost to the Federal Government
The annual cost to the Federal Government is approximately $61,131. This estimate is a projection of the costs for printing and distributing the collection instruments and for collecting and processing the information.
Program Changes or Adjustments to the Information Collection
The number of respondents decreased since the last information collection due to fewer redeterminations conducted.
Plans for Publication Information Collection Results
SSA will not publish the results of this information collection.
Displaying the OMB Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB approval date on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that 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 that we would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
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).
Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
0960-0723 revisions (SSA-1026)
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT FOR FORMS SSA-L1026, SSA-1026-RET, SSA-1026-SCE |
| Author | Faye I. Lipsky |
| Last Modified By | 889123 |
| File Modified | 2011-12-19 |
| File Created | 2011-08-23 |