Respondent Correspondence for Incentive Experiment

ATTACHMENT D
RESPONDENT CORRESPONDENCE FOR INCENTIVE EXPERIMENT

ATTACHMENT D1
SSA ADVANCE LETTER

SOCIAL SECURITY
Para información e instrucciones en español, llame por favor.

Date
NAME
ADDRESS 1
ADDRESS 2
CITY, STATE ZIP
Dear :
We need your help with an important study by Social Security Administration, called the
National Beneficiary Survey (NBS). The NBS gathers information about the health and wellbeing of people who receive Social Security Disability Insurance (SSDI) or Supplemental
Security Income (SSI). The study will help us learn how well our programs meet the needs of
people like you.
Although taking part is your choice, your input will help make our programs better. Your answers
represent others like you all across the country, so your taking part is very important to the
success of the survey. We will use the answers you provide only for research. SSA will not
share your answers in any way that reveals who you are. SSA will not use your information to
make decisions about your disability benefits.
We have hired Mathematica Policy Research (Mathematica) for this survey. In about three
weeks, someone from Mathematica will call to speak with you. To thank you for your time,
Mathematica will send you a $20 gift card after you complete the interview.
If you call Mathematica toll-free at [PHONE] and complete the interview
on or before [DATE] you will receive
an extra $10 on your gift card, for a total of $30.
If you want to set up a time to talk or need help to take part in the survey, please call
Mathematica at 888-888-8888 (toll-free) or send an email to [email protected].
Mathematica’s TTY number is 888-888-8888.
To learn more about the NBS, please see the brochure included in this letter or log on to
www.insert.com.
We look forward to speaking with you. Thank you for your participation.
.
Sincerely,
David Weaver
Associate Commissioner
Office of Program Development and Research
Office of Retirement and Disability Policy

Privacy Act Statement
Collection and Use of Personal Information

Public Law 106-170 Section 101 (1)(d)(4)(C)(i), allows us to collect this information. We will use
your answers to learn more about disability beneficiaries, how well our programs are working,
and design new programs. The information will solely be used for research purposes to
improves SSA's programs and policies.
Participation is voluntary and participating or not participating will not affect your benefits.
We use the information you supply primarily for the purposes stated above. However, we may
use it for the administration and integrity of our programs. We may also disclose information to
another person or to another agency in accordance with approved routine uses, which include
but are not limited to the following:
1. To comply with Federal laws requiring the release of information from Social Security
records (e.g. to the Government Accountability Office and Department of Veterans
Affairs);
2. To facilitate statistical research, audit, or investigative activities necessary to assure the
integrity and improvement of Social Security programs, including responding to
questions from Congress.
A complete list of when we may share your information with others, called routine uses, is
available in our Privacy Act System of Records Notice 60-0058, Master Files of Social Security
Number (SSN) Holders and SSN Applications. Additional information about this and other
system of records notices and our programs is available from our Internet website at
www.socialsecurity.gov or at your local Social Security office.

Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section
2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless
we display a valid Office of Management and Budget (OMB) control number. The OMB control
number for this collection is XXXX-XXXX; expiration date XX/XX/XXXX. We estimate that it will
take about 45 minutes to read the instructions, and answer the questions. You may send
comments on our time estimate to: Social Security Administration, 6401 Security Blvd,
Baltimore, MD 21235-6401.

ATTACHMENT D2
REMINDER POSTCARD

You have been chosen to participate in an important health
survey for the Social Security Administration. After you complete
the survey, we will send you a $20 Target or Walmart gift card –
you get to choose.
CALL 1-800-XXX-XXXX

COMPLETE SURVEY

GET $20 GIFT CARD

$20

If you call Mathematica toll-free at [PHONE] and complete the
interview on or before [DATE] you will receive
an extra $10 on your gift card, for a total of $30.

ATTACHMENT D3
SSA REMINDER LETTER

SOCIAL SECURITY
Para información e instrucciones en español, llame por favor.

Date
NAME
ADDRESS 1
ADDRESS 2
CITY, STATE ZIP
Dear :
We recently sent you a letter about an important study by Social Security Administration, called
the National Beneficiary Survey (NBS). The NBS gathers information about the health and
well-being of people who receive Social Security Disability Insurance (SSDI) or Supplemental
Security Income (SSI). The study will help us learn how well our programs meet the needs of
people like you.
Although taking part is your choice, your input will help make our programs better. Your answers
represent others like you all across the country, so your taking part is very important to the
success of the survey. We will use the answers you provide only for research. SSA will not
share your answers in any way that reveals who you are. SSA will not use your information to
make decisions about your disability benefits.
We have hired Mathematica Policy Research (Mathematica) for this survey. In the next few
weeks, someone from Mathematica will call to speak with you. To thank you for your time,
Mathematica will send you a $20 gift card after you complete the interview.
If you call Mathematica toll-free at [PHONE] and complete the interview
on or before [DATE] you will receive
an extra $10 on your gift card, for a total of $30.
If you want to set up a time to talk or need help to take part in the survey, please call
Mathematica at 888-888-8888 (toll-free) or send an email to [email protected].
Mathematica’s TTY number is 888-888-8888.
To learn more about the NBS, please see the brochure included in this letter or log on to
www.insert.com.
We look forward to speaking with you. Thank you for your participation.
Sincerely,
David Weaver
Associate Commissioner
Office of Program Development and Research
Office of Retirement and Disability Policy

Privacy Act Statement
Collection and Use of Personal Information

Public Law 106-170 Section 101 (1)(d)(4)(C)(i), allows us to collect this information. We will use
your answers to learn more about disability beneficiaries, how well our programs are working,
and design new programs. The information will solely be used for research purposes to
improves SSA's programs and policies.
Participation is voluntary and participating or not participating will not affect your benefits.
We use the information you supply primarily for the purposes stated above. However, we may
use it for the administration and integrity of our programs. We may also disclose information to
another person or to another agency in accordance with approved routine uses, which include
but are not limited to the following:
1. To comply with Federal laws requiring the release of information from Social Security
records (e.g. to the Government Accountability Office and Department of Veterans
Affairs);
2. To facilitate statistical research, audit, or investigative activities necessary to assure the
integrity and improvement of Social Security programs, including responding to
questions from Congress.
A complete list of when we may share your information with others, called routine uses, is
available in our Privacy Act System of Records Notice 60-0058, Master Files of Social Security
Number (SSN) Holders and SSN Applications. Additional information about this and other
system of records notices and our programs is available from our Internet website at
www.socialsecurity.gov or at your local Social Security office.

Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section
2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless
we display a valid Office of Management and Budget (OMB) control number. The OMB control
number for this collection is XXXX-XXXX; expiration date XX/XX/XXXX. We estimate that it will
take about 45 minutes to read the instructions, and answer the questions. You may send
comments on our time estimate to: Social Security Administration, 6401 Security Blvd,
Baltimore, MD 21235-6401.