Addendum to the Supporting Statement 0960-0012

Addendum to the Supporting Statement for Form SSA-7-F6

Application for Parent’s Insurance Benefits

20 CFR 404.370, 20 CFR 404.371, 20 CFR 404.373, 20 CFR 404.374 and

20 CFR 404.601 404.603

OMB No. 0960-0012

Revisions to the Collection Instrument

SSA is making the following revisions:

Change 1: Page 1-question 1(b), revised language from

Check (X) one for the Deceased

To: Mark the gender of the Deceased

Justification 1: Revise the statement to clearly instruct the reader as to what information to provide. The revised statement is consistent with the other statements and questions on the form.  The reader will mark “X,” rather than check “X,” which is consistent with the language used throughout the form. Also, “check (X) one” is not a complete thought, and it is ambiguous.

Change 2: Page 1- question 2, added a field for gender of the claimant:

“Check (X) whether you are Male or Female”.

Justification 2:  We have a similar field for the claimant in the RIB application, so this would be consistent with what we ask other claimants.  It would also be helpful in determining whether we would recognize as valid a claimant’s marriage that took place after the worker’s death.  To be entitled as a parent, a claimant must not have married after the worker’s death (with a few exceptions).  This would help us determine if a marriage was same-sex. If it is a same-sex marriage, we must follow the Windsor policy.

Change 3: Page 1-item 2(b) and item 2(c), renumbered these items.

Justification 3: We renumbered these items following the addition of a field for gender.

Change 4: Page 3- Medicare Information, revise the language from:

If this claim is approved and you are still entitled to benefits at age 65, or you are within 3 months of age 65 or older you could automatically receive Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage at age 65. If you are not eligible for automatic enrollment in Medicare Part B, and you will need to contact Social Security to request enrollment.

To:

If this claim is approved and you are still entitled to benefits at age 65, or you are within 3 months of age 65 or older you could automatically receive Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage at age 65. If you live in Puerto Rico or a foreign country, you are not eligible for automatic enrollment in Medicare Part B, and you will need to contact Social Security to request enrollment.

Justification 4: Add information about people living in Puerto Rico or a foreign country not being eligible for automatic enrollment in Medicare Part B.

Change 5: Page 4- second part “Medicare Information” section—revised the information in this section from:

Medicare Part B (Medical Insurance)- helps cover a doctor's services and outpatient care. It also covers some other services that Medicare Part A doesn’t cover, such as some of the services of physical and occupational therapists and some home health care. If you enroll in Medicare Part B, you will have to pay a monthly premium. The amount of your premium will be determined when your coverage begins. In some cases, your premium may be higher based on information about your income we receive from the Internal Revenue Service. Your premiums will be deducted from any monthly Social Security, Railroad Retirement, or Office of Personnel Management benefits you receive. If you do not receive any of these benefits, you will get a letter explaining how to pay your premiums. You will also get a letter if there is any change in the amount of your premium.

You can also enroll in a Medicare prescription drug plan (Part D). To learn more about Medicare prescription drug plans and when you can enroll, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Medicare can also tell you about agencies in your area that can help you choose your prescription drug coverage.

If you have limited income and resources, we encourage you to apply for the Extra Help that is available to assist you with Medicare prescription drug costs. The Extra Help can pay the monthly premiums, annual deductibles, and prescription co-payments. To learn more or apply, please visit www.socialsecurity.gov, call 1-800-772-1213 (TTY 1-800-325-0778) or visit the nearest Social Security office.

To:

Medicare Part B (Medical Insurance) helps cover doctor's services and outpatient care. It also covers some other services that Medicare Part A does not cover, such as some of the services of physical and occupational therapists and some home health care. If you enroll in Medicare Part B, you will have to pay a monthly premium. The amount of your premium will be determined when your coverage begins. In some cases, your premium may be higher based on information about your income we receive from the Internal Revenue Service. Your premiums will be deducted from any monthly Social Security, Railroad Retirement, or Office of Personnel Management benefits you receive. If you do not receive any of these benefits, you will get a letter explaining how to pay your premiums. You will also get a letter if there is any change in the amount of your premium.

You can also enroll in a Medicare prescription drug plan (Part D). To learn more about the Medicare prescription drug plans and when you can enroll, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Medicare can also tell you about agencies in your area that can help you choose your prescription drug coverage. The amount of your premium varies based on the prescription drug plan provider. The amount you pay for Part D coverage may be higher than the listed plan premium, based on information about your income we receive from the Internal Revenue Service.

If you have limited income and resources, we encourage you to apply for the Extra Help that is available to assist you with Medicare prescription drug costs. The Extra Help can pay the monthly premiums, annual deductibles, and prescription co-payments. To learn more or apply, please visit www.socialsecurity.gov, call 1-800-772-1213 (TTY 1-800-325-0778) or visit the nearest Social Security office.

Justification 5: We revised to add language about the cost of Medicare Drug Plans.

Change 6: Page 6, sixth bulleted item in the left column—we changed this statement from:

You are confined to jail, prison, penal institution or correctional facility for conviction of a crime or confined to a public institution by court order in connection with a crime.

To:

You are confined to a jail, prison, penal institution or correctional facility for more than 30 continuous days for conviction of a crime, or you are confined for more than 30 continuous days to a public institution by a court order in connection with a crime.

Justification 6: This change is necessary in order for the reporting responsibility to conform to the non-payment requirements of the Social Security Act in section 202(x)(1).

Change 7: Page 6, seventh bulleted item in the left column—we changed this statement from:

You have an unsatisfied warrant for your arrest for a crime or attempted crime that is a felony (or, in jurisdictions that do not define crime as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year).

To:

You have an unsatisfied warrant for more than 30 continuous days for your arrest for a crime or attempted crime that is a felony of flight to avoid prosecution or confinement, escape from custody and flight-escape. In most jurisdictions that do not classify crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding one year (regardless of the actual sentence imposed).

Justification 7: We changed this reporting responsibility because of the Martinez Settlement. The Martinez Settlement is a nation-wide class action settlement that caused us to no longer suspend benefits for an outstanding felony warrant unless the warrant was issued for a crime or attempted crime of flight to avoid prosecution or confinement, escape from custody and flight-escape.

Change 8: Page 6, eighth bulleted items in the left column—we changed this statement from:

You have an unsatisfied warrant for a violation of probation or parole under Federal or State law.

To:

You have an unsatisfied warrant for more than 30 continuous days for a violation of probation or parole under Federal or State law.

Justification 8: This change is necessary due to the Clark Court Order (dated 3/19/10) requiring that we no longer suspend benefits based on an outstanding probation or parole violation warrant.

Change 9: Page 6, “How to Report” section—changed the language in the first sentence of this section from:

You can make your reports by telephone, mail, or in person, whichever you prefer.

To:

You can make your reports online, by telephone, mail, or in person, whichever you prefer.

Justification 9: We made this change to let claimants know they can make some changes online.

Change 10: Page 6: “How to Report” section--added the following bullet at the top to reflect the online services reporting option

“Visiting the section “my Social Security” at our web site at www.socialsecurity.gov.”

Justification 10: We added this bullet because of SSA’s addition of “my SSA” and to let claimants know they can make some changes online.

Creating a Different Modality of Your IC

We are requesting clearance of a fillable Internet-based version of the SSA-7. This version, which respondents can complete online, will save time for both respondents and SSA field office employees.

Other Minor Revisions to the Collection Instrument

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. The revised Privacy Act Statement can be found under the collection instruments’ supplemental documents tab on ROCIS.