Non-substantive change request SSA-787

Justification for Non-Substantive Changes for Form SSA-787

Physician’s/Medical Officer’s Statement of Patient’s Capability to Manage Benefits

20 CFR 404.2015 and 416.615

OMB No. 0960-0024

Background

The Social Security Administration (SSA) uses Form SSA-787 to collect medical evidence to determine beneficiaries’ capability or inability to handle their own benefits, and to assist in determining the beneficiaries’ need for a representative payee. Currently, the respondent can complete Form SSA‑787 and mail it back to SSA, or an SSA employee can fill out the form over the phone or through a face-to-face interview. At this time, claimants must print the blank PDF and fill it out using a pen, or they need to use a typewriter to complete the form. As some handwriting is difficult to read, or illegible, these non-fillable versions of the form are inefficient and ineffective since SSA employees who cannot read the submitted form must re-contact the respondent prior to processing. In addition, the use of typewriters decreased significantly, as other tools, such as personal computing devices, increase in use.

SSA developed a fillable, printable version of the SSA-787, as some individuals may find it easier to use. The fillable version allows the respondents to complete the form electronically using a personal computer, or other computing device, print the completed form, and submit it to SSA. We developed this fillable version, as we want to ensure SSA provides effective communication and remains in compliance with the requirements of 45 CFR 85.51 of the Code of Federal Regulations and section 504 of the Rehabilitation Act of 1973. We propose the fillable PDF version as a more accessible modality. In addition, the new fillable modality will enhance our electronic services and recordkeeping efforts.

Revisions to the Information Collection

• Change #1: SSA intends to provide Form SSA-787 in a fillable PDF file on our website, in place of the non-fillable PDF version we currently provide. We propose to make all form entries fillable.

Justification #1: This change will allow the respondents to continue to print and complete the form by hand, or, alternatively, complete the form using a computing device, such as a personal computer or handheld (mobile) device, print, and submit the form to SSA for processing.

After OMB approves the addition of the new fillable version of the form, SSA will phase out the standard PDF versions from our Internet and Intranet websites and replace them with the fillable PDF file.

This action does not affect the public reporting burden.