Supporting Statement 0742(revised)

Supporting Statement for SSA-371

Request for Reinstatement (Title II)

20 CFR 404.1592b-404.1592f

OMB #0960-0742

1. Justification

1. Introduction/Authorizing Laws and Regulations

The Social Security Administration (SSA) allows certain previously entitled beneficiaries to request expedited reinstatement (EXR) of disability benefits under title II of the Social Security Act (the Act) when their medical condition no longer permits them to perform substantial gainful activity.

Section 223(i) of the Social Security Act (the Act) and Sections 20 CFR 404.1592b through 20 CFR 404.1592f) of the Code of Federal Regulations require the Commissioner of SSA to provide regulations for administering the disability provisions of the law.

2. Description of Collection

SSA uses Form SSA–371 to obtain (1) a signed statement from individuals requesting an EXR of their title II disability benefits, and (2) proof the requestors meet the EXR requirements. SSA maintains the form in the disability folder of the applicant to demonstrate the requestors’ awareness of the EXR requirements, and their choice to request EXR. Respondents are applicants for EXR of title II disability benefits.

3. Use of Information Technology to Collect the Information

SSA did not create an electronic version of form SSA-371 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 10,000 respondents complete the form. This is less than the GPEA cut-off of 50,000.

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 significantly 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-371, we could not ensure that persons who are requesting EXR are aware of the requirements and that they have made the choice to request EXR. Because we collection this information on an as needed basis, we cannot collect the information less frequently.

There are no technical or legal obstacles that prevent 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 October 24, 2012, at

77 FR 65047, and we received no public comments. The 30-day FRN published on December 28, 2012 at 77 FR 76591. If we receive any comments in response to this Notice, we will forward them to OMB.

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

Modality of completion	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Estimated Total Annual Burden (hours)
SSA-371	10,000	1	2	333

Approximately 10,000 respondents take 2 minutes each to complete form SSA-371 each year. Accordingly, the burden is 333 burden hours. This figure represents burden hours, and we did not calculate a separate cost burden.

13. Annual Cost to the Respondents (Others)

This collection does not impose a known cost burden to the respondents.

14. Annual Cost to Federal Government

The annual cost to the Federal Government is $46,200. 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 are no changes to the public reporting burden.

16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

17. Displaying 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 1 320.9 and related provisions at 5 CFR 1320.8(b)(3).

2. Collections of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.