Annual Earning Test Direct Mail Follo-up Program Notices

5

Addendum for Supporting Statement for Forms SSA-L9778, SSA-L9779, SSA-L9781

SSA-L9784, SSA-L9785 and SSA-L9790

Annual Earnings Test Direct Mail Follow-up Program Notices

20 CFR 404.452-404.455

OMB No. 0960-0369

Non-Substantive Change Request

SSA-L9778, SSA-L9779, SSA-L9781, SSA-L9784, SSA-L9785 and SSA-L9790

Change 1: We are revising all cover letters for each form contained in this clearance package.

Justification 1: We revised the cover letters because of feedback from readers who state they find them confusing with all the information they contain. The new cover letters contain headings, spells out what information we are requesting, and clearly states how to contact us if questions arise.

Change 2: We are revising the “Signature” section on all the forms. The prior signature section blended in with the form language. The new section contains a “Signature” heading that stands out from the form language. We also removed the paragraph, “Please sign this form in the space below…..”

Justification 2: By creating a “Signature” heading, the reader can clearly see that we need a signature, date, and daytime telephone number. We removed the paragraph since we now use similar language in the cover letters.

SSA-L9778, SSA-L9779, SSA-L9781, SSA-L9784, SSA-L9785

Change 3: We are reformatting the “Estimate Your Earnings…” instructions page. The prior version for bullet 2 contained a statement and additional bulleted information. We removed the bullets from the additional information and added dashes. The prior version for bullet 3 was a paragraph that contained numbers 1 and 2. We separated the numbers 1 and 2 from the paragraph and replaced the numbers with dashes.

Justification 3: By adding the dashes, we differentiate the material indicated by bullets. We separated the numbers 1 and 2 from the paragraph so that the instructions are clearer to the reader and not blended in with the other language.

SSA-L9778

Change 4: We are revising questions 1 and 3

Questions 1 and 3 - the prior version contained only one earnings box that included a section for any cents. We revised questions 1 and 3 to add a box for self-employment, removed the section for cents, and added a statement to use dollar amounts only and to round cents to the nearest whole dollar.

Justification 4: The revisions to these questions will remind the reader to include any self-employment income in his or her total earnings amount. We removed the cents section because it is not required and the majority of the readers provide us with whole dollar amounts.

SSA-L9779

Change 5: We are revising questions 1 and 5.

Current Language:

• Revised Language:

Justification 5: We removed the cents section, because it is not required and the majority of the readers provide SSA with whole dollar amounts.

Change 6: We are revising question 2.

• Current Language:

• New Language:

Justification 6: We revised the language in the questions based on feedback from WBDOC staff that identified these questions as problem areas based on the submissions they receive for processing. We added tick and segmented boxes on certain questions for scan ability purposes, which allows WBDOC staff to process the forms more efficiently.

Change 7: We are revising question 3.

• Current Language:

• Revised Language:

Justification 7: We revised the language in the questions based on feedback from WBDOC staff that identified these questions as problem areas based on the submissions they receive for processing. We added tick and segmented boxes on certain questions for scan ability purposes, which allows WBDOC staff to process the forms more efficiently.

. Question 3 – prior version “If you are self-employed, how many hours will you work each ….” Current version - “If you are self-employed, enter how many hours you will work each month for (year). Enter “0” if you will not work any hours for that month. Be sure to show hours for…”, added segmented boxes and an example for completing the segmented boxes.

Justification 5: Questions 1 and 5 - we removed the cents section because it is not required and the majority of the readers provide us with whole dollar amounts. Questions 2 and 3 – We revised the language in the questions based on feedback from WBDOC staff that identified these questions as problem areas based on the submissions they receive for processing. We added tick and segmented boxes on certain questions for scan ability purposes, which allows WBDOC staff to process the forms more efficiently.

Change 6: SSA-L9781 – same as change 5 for the SSA-L9779 above.

Justification 6: The justification for this form is the same as the justification 5 above.

Change 7: SSA-L9784 – Questions 1 and 2 – prior versions contained a section for cents in the box for earnings. Current versions - removed the section for cents and added a statement to use dollar amounts only and to round cents to the nearest whole dollar.

Justification 7: We removed the cents section because it is not required and the majority of the readers provide us with whole dollar amounts.

Change 8: SSA-L9785 – Questions 1 and 2 - prior versions contained a section for cents in the box for earnings. Current versions - removed the section for cents and added a statement to use dollar amounts only and to round cents to the nearest whole dollar. Question 3 – prior version, “If you work for wages, put an “X” in the box under each month when you will earn (amount) or less up to but not including the month you become full retirement age”. Current version, “ Place an “X” in the box under each month when you will earn (amount) or less up to but not including the month you become full retirement age” and added tick boxes. Question 4 – current version added segmented boxes and an example for completing the segmented boxes.

Justification 8: Questions 1 and 2 - We removed the cents section because it is not required and the majority of the readers provide us with whole dollar amounts. Question 3 - We revised the language in this question based on feedback from WBDOC staff that identified this question as a problem area based on the submissions they receive for processing. We added tick and segmented boxes on certain questions for scan ability purposes, which allows WBDOC staff to process the forms more efficiently.

Change 9: SSA-L9790 – Question 1 – prior version “If you worked for wages, put an “X”….” Current version - “Place an X in the box under each month….” and added tick boxes. Question 2 - prior version “If you were self-employed, how many hours did you work each ….” Current version - “If you are self-employed, enter how many hours you worked each month for (year). Enter “0” if you will not work any hours for that month. Be sure to show hours for…”, added segmented boxes, and an example for completing the segmented boxes.

Justification 9: We revised the language in these questions based on feedback from WBDOC staff that identified these questions as problem areas based on the submissions they receive for processing. We added tick and segmented boxes on certain questions for scan ability purposes, which allows WBDOC staff to process the forms more efficiently.

We plan to implement these changes upon OMB approval since the next mailing of these forms occurs in early 2014.