Statement for Determining Continuing Eligibility for Supplemental Security Income Payments

Forms and Documents

Document Name	Status
Form SSA-8202-BK Statement for Determining Continuing Eligibility, Supplemental Security Income Payment--BK Form	Modified
Addendum - 0145.doc Supplementary Document	2016-03-07
Supporting Statement - 0145.docx Supporting Statement A	2016-03-15

IC Document Collections

IC ID	Document Title	Status
45420	Statement for Determining Continuing Eligibility, Supplemental Security Income Payment-- MSSICS SCREENS Other-MSSICS	Modified
45419	Statement for Determining Continuing Eligibility, Supplemental Security Income Payment--BK Form	Modified

ICR Details

OMB Control No: 0960-0145	ICR Reference No: 201601-0960-006
Status: Historical Active	Previous ICR Reference No: 201211-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement for Determining Continuing Eligibility for Supplemental Security Income Payments
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/19/2016
	Date Received in OIRA: 03/15/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	36 Months From Approved	04/30/2016
Responses	2,299,906	0	78,077
Time Burden (Hours)	766,807	0	26,137
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses form SSA-8202-BK to conduct low-and middle-error-profile (LEP-MEP) telephone or face-to-face redeterminination (RZ) interviews with Supplemental Security Income (SSI) recipients and representative payees. The information SSA collects during the interview is needed to determine whether SSI recipients have met and continue to meet all statutory and regulatory requirements for SSI eligibility and whether they have been, and are still receiving, the correct payment amount.

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Authorizing Statute(s): US Code: 42 USC 1382 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 81409	12/29/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 11636	03/04/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Statement for Determining Continuing Eligibility, Supplemental Security Income Payment-- MSSICS SCREENS
Statement for Determining Continuing Eligibility, Supplemental Security Income Payment--BK	SSA-8202-BK	Statement for Determining Continuing Eligibility Supplemental Security Income Payment

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,299,906	78,077	0	2,221,829	0	0
Annual Time Burden (Hours)	766,807	26,137	0	740,670	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The significant increase in burden hours is due to actual estimates provided for the respondents who completed the information collection via MSSICS. The last IC contained incomplete estimates.

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Annual Cost to Federal Government: $19,928,172

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/15/2016

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