Supporting Statement for Form SSA-8001-BK
Application for Supplemental Security Income
20 CFR 416.305 - 20 CFR 416.335, Subpart C
OMB No. 0960-0444
A. Justification
Introduction/Authoring Laws and Regulations
Section 1631(e)(1) of the Social Security Act (the Act) requires the Commissioner of the Social Security Administration (SSA) to promulgate regulations concerning applications for Supplemental Security Income (SSI) benefits. Section
20 CFR, 416.305-416-.335 of the Code of Federal Regulations provides that the information we request for SSI benefits be on a prescribed form.
Description of Collection
SSA collects information on the SSA-8001-BK to determine an applicant’s eligibility for SSI and the SSI payment amounts. SSA employees also collect this information during interviews with members of the public who wish to file for SSI. SSA uses the information for two purposes: (1) to formally deny SSI for non- medical reasons when information the applicant provides results in ineligibility; or (2) to establish a disability claim, but defer the complete development of
non-medical issues until SSA approves the disability. The respondents are applicants of SSI benefits.
Use of Information Technology to Collect the Information
SSA uses the Modernized Supplemental Security Income Claims System (MSSICS) to document information we obtain from the claimant and to provide application output for the claimant's signature.
We use Form SSA-8001-BK for approximately two percent of the claims in case of a temporary computer failure.
In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Intranet version of Form SSA-8001. Based on our data, we estimate approximately 98% of respondents under this OMB number respond electronically.
Why We Cannot Use Duplicate Information
Form SSA-8001-BK (OMB No. 0960-0444) and Form SSA-8000-BK, Application for Supplemental Security Income (OMB No. 0960-0229) both collect this type of information. We use Form SSA-800-BK over Form SSA-8000 when we are taking an abbreviated application (i.e., claimants does not meet the non-medical requirements and they will be denied for that reason). We use Form SSA-8001 when we will defer non-medical development until after we get a medical decision. However, the respondent only has to complete one form. Therefore, respondents only have to provide the information once.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
6. Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-8000-BK the claimants expressing interest in filing for SSI benefits would not be able to supply the information or file at that time. If the claimant is unable to file at that time, there is a potential loss of SSI eligibility, and in some states, Medicaid benefits. In addition, any delay in securing the information would result in a delay in determining eligibility and in making the initial payment if the claimant is eligible. 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.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on January 03, 2011, at
77 FR 147, and we received no public comments. The 30-day FRN published on March 30, 2012 at 77 FR 19406. 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.
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 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.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Collection Method |
Number of respondents |
Frequency of response |
Average burden per response (minutes) |
Estimated total annual burden (hours) |
MSSICS/Signature Proxy |
1,006,400 |
1 |
15 |
251,600 |
MSSICS/Wet Signature |
326,400 |
1 |
14 |
76,160 |
Paper |
27,200 |
1 |
18 |
8,160 |
Totals |
1,360,000 |
|
|
335,920 |
The total burden for this ICR is 335,920. 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.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $149,002. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
15. Program Changes or Adjustments to the Information Collection Request
There has been an increase in burden hours. This change stems from an increase in the number respondents applying for benefits.
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.
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.
| File Type | application/msword |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| Last Modified By | 889123 |
| File Modified | 2012-04-03 |
| File Created | 2011-12-06 |