Homeless with Schizophrenia Presumptive Disability (HSPD) Pilot Demonstration

Forms and Documents

Document Name	Status
Presumptive Disability Recommendation Form Form and Instruction	New
Supporting Statement - HSPD.docx Supporting Statement A	2012-02-28

IC Document Collections

IC ID	Document Title	Status
201339	Presumptive Disability Recommendation Form Form and Instruction	New

ICR Details

OMB Control No: 0960-0793	ICR Reference No: 201202-0960-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Homeless with Schizophrenia Presumptive Disability (HSPD) Pilot Demonstration
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/29/2012
	Date Received in OIRA: 03/02/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved
Responses	208	0	0
Time Burden (Hours)	35	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Social Security Administration (SSA) proposes to pilot an administrative change in the Supplemental Security Income (SSI) program, in which we allow a psychiatrist or psychologist to use a Presumptive Disability Recommendation Form to recommend SSA make Presumptive Disability (PD) payments to homeless individuals with schizophrenia or schizoaffective disorder. The purpose of the pilot is to determine whether the use of the recommendation form improves the quality of the evidence supporting the application, as demonstrated by a higher allowance rate at the initial level of application. PD is a policy allowing an individual applying for SSI based on a disability to receive up to six months of payments prior to SSA's final disability determination. For SSA to confer a PD, there must be strong evidence that we would find the individual disabled. Applicants are not required to pay back this money if SSA ultimately denies their applications, as long as SSA did not deny the applications for nonmedical reasons. SSA field offices generally make PD findings only for specific disability categories, which do not include schizophrenia or schizoaffective disorder. This pilot allows field offices in San Francisco and Santa Cruz to make PD findings for applicants who are homeless and who have a diagnosis of schizophrenia or schizoaffective disorder. We partnered with the San Francisco City and County, and Santa Cruz County social and health services agencies to conduct this pilot. We chose them because they already are conducting, as part of their regular work, all of the services necessary to support the pilot. These agencies identify homeless individuals, help those individuals through the SSI application process, and ensure the applicants have all of the medical evidence necessary to support an SSI application. The only change to their regular work protocol they will need to make for the SSA PD form pilot will be to fill out a schizophrenia PD recommendation form for those amongst their adult clients who are homeless and have schizophrenia or schizoaffective disorders. The form follows SSA's Listing of Impairments, which provides the criteria necessary to meet SSA's definition of impairment. In addition, the form helps medical staff provide the correct information for a sound and prompt PD determination. Respondents are medical staff from the San Francisco City and County, and Santa Cruz County social and health services agencies who help homeless SSI applicants with schizophrenia or schizoaffective disorder complete SSI applications.

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Authorizing Statute(s): US Code: 42 USC 1310 Name of Law: The 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:
	76 FR 68805	11/07/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 2114	01/13/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Presumptive Disability Recommendation Form	N/A	Schizophrenia Presumptive Disability Recommendation Form

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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	208	0	0	208	0	0
Annual Time Burden (Hours)	35	0	0	35	0	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: This new program increases the public reporting burden. See chart above for the burden figures.

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Annual Cost to Federal Government: $0

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: 03/02/2012

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