Addendum to the Supporting Statement OMB No. 0960-0133

Addendum to the Supporting Statement for Form SSA-8508 BK

Supplemental Security Income (SSI)

Quality Review Case Analysis

OMB No. 0960-0133

Minor Revisions to the Collection Instrument

e8508 Start-Up Form screen [see e8508.pdf, page 1]

• Change: Replaced “Case Review Information” header with “Type of Interview” header and re-arranged fields.

• Justification: Clarified and eliminated unnecessary fields.

• Change: Removed “Interviewer Name” field.

• Justification: This field is redundant in the SSA-8508 BK form as eQA provides case assignment information.

• Change: Removed “Face-to-Face” checkbox.

• Justification: We no longer conduct personal interviews.

• Change: Moved and replaced “Case Review Information” header with “Other Case Information.”

• Justification: Rearranged fields for efficiency.

• Change: Added field, “Do Support Materials Include a 1099?

• Justification: Reminder for reviewers to address 1099 alerts.

e8508 Start-Up Form screen [see e8508.pdf, pages 2-3]

Death of Sampled Individual and Eligible Spouse screens

Change: Added two separate screens.

Justification: Assists the reviewer with policy procedures for death case processing.

Element 1, Proof of Identity/SSN (Phone interview screen) [see e8508.pdf, page 4]

• Change: Eliminated Match, Interview, Evidence, and Proven fields, and modified screen to capture determinations.

• Justification: Simplified to incorporate telephone review protocol implementation.

Element 1, Proof of Identity/SSN (Phone interview screen for SI and ES) [see e8508.pdf, pages 5-6]

• Change: Added “QR: Proof of Identity”, “QR: Proof of SSN”, and “GN: Additional Information Used to Verify Identity” links.

• Justification: Assists reviewers with policy questions.

• Change: Added “Determination Screen” button.

• Justification: Navigation enhancement.

• Change: Added a match option for the “Other Information” field.

• Justification: Uniformity within the form.

Element 1, Proof of Identity/SSN (Non-Organizational Payee screen for SI and ES) [see e8508.pdf, page 7&9]

• Change: Added “QR: Proof of Identity”, “QR: Proof of SSN”, and “GN: Additional Information Used to Verify Identity” links.

• Justification: Assists reviewers with policy questions.

• Change: Added “Determination Screen” button.

• Justification: Navigation enhancement.

Element 1, Proof of Identity/SSN (Organizational Payee screen for SI and ES) [see e8508.pdf, pages 8&10]

• Change: Added “QR: Proof of Identity”, “QR: Proof of SSN”, and “GN: Additional Information Used to Verify Identity” links.

• Justification: Assists reviewers with policy questions.

• Change: Added “Determination Screen” button.

• Justification: Navigation enhancement.

• Change: Modified labels for “Contact Name” and “Title” fields to “Organization’s Contact Name” and “Organization’s Contact Title”, respectively.

• Justification: Labels are more descriptive.

Element 3, NATURALIZED CITIZEN/ALIEN STATUS screen (if applicable) [see e8508.pdf, pages 14-15]

• Change: Rearranged the sequence of the “Country of Birth” and “Type of Evidence” fields for both the SI and ES screens.

• Justification: Follows sequence of interview process.

Element 4, Continuous Residency in US screen [see e8508.pdf, pages 16-18]

• Change: Added question, “Last date the ES was outside the U.S.?”

• Justification: Correction made to address eligible spouse cases.

• Change: Added “Was the Ticket Refundable?” and “Unearned Income Suspected?” fields for both the SI and ES screens.

• Justification: Addressed POMS development procedures.

Element 6, Living Arrangement (LA) - (Rental Liability screen) [see e8508.pdf, pages 52-61]

• Change: Added “Type” field to this screen.

• Justification: Clarified type of rental liability.

Element 6, Living Arrangement (LA) - (Household Composition screen) [see e8508.pdf, pages 87-92]

• Change: Added “Total number of ineligible siblings” field.

• Justification: Addresses number of siblings when the sampled individual is a child.

• Change: Added Student Status button.

• Justification: Allows access to this screen in situations when student status development is required, but the individual does not have income.

Ineligible Children Names screen [see e8508.pdf, page 93]

• Change: Modified the text in the label.

• Justification: Addresses siblings in addition to ineligible children.

• Change: Added “Was the IC/Sibling a student during the review period?” field.

• Justification: Addresses both ineligible children and siblings’ student status.

Element 6, Living Arrangement (LA) - (LA/ISM Determination screen) [see e8508.pdf, pages 131-139]

• Change: Added “Unstated Income Suspected?” field.

• Justification: Reminder for reviewer to address unstated income in subsequent income screens.

Student Information screen [see e8508.pdf, pages 169-176]

• Change: Added “Deeming Allocation Applies?” field to the ineligible children’s screen(s).

• Justification: Addressed POMS development procedures.

• Change: Added “Add Remarks” button.

• Justification: Available to document development issues.

Element 9, Unearned Income (main screen) [see e8508.pdf, pages177-179]

• Change: Added, “Unstated Income” field.

• Justification: Addressed POMS development procedures.

• Change: Added systems data for the eligible spouse.

• Justification: Assists in developing eligible couple case.

Unstated Income Development screen [see e8508.pdf, page 180]

• Change: Added unstated income development screen.

• Justification: Assist reviewers in developing unstated income.

Element 10, Financial Institution Accounts (main screen) [see e8508.pdf, page 203-]

• Change: Added direct deposit systems data for the eligible spouse.

• Justification: Assists in developing in eligible couple case.

Element 10, Financial Institution Accounts (detail screen) [see e8508.pdf, pages 208, 213, & 217]

• Change: Spelled out abbreviations in the “Additional” section i.e. number, account, balance.

• Justification: Clarified labels.

• Changed: Replaced “Total Savings Acct BAL” with “Countable Savings Account Balance.”

• Justification: Clarified labels.

Element 11, Other Liquid Resources (detail screens) [see e8508.pdf, pages 234-235, 251-252, 268-269]

LIP Div. Accum. screen

• Change: Added “Insurance Company” field.

• Justification: Provides additional information about the source of the life insurance policy dividend accumulations.

Element 13, Negative Property Search screen [see e8508.pdf, pages 278-282]

• Change: In the SI screen, removed all fields except the “Determination” and “Record the number of properties found” fields. Added SSN(s) Search fields.

• Justification: Negative property searches are conducted by SSN using Accurint.

• Change: In the MI-1 and MI-2 screens, added “SSN Search” and “Name Search” screens.

• Justification: Negative property searches are conducted by SSN using Accurint. The Name Search is used when ineligible parent(s) or spouse does not have an SSN.

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.

SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the first page of the form.