Statement for Determining Continuing Eligibility for Supplemental Security Income Payments

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-8203 Determining Continuing Eligibility for Supplemental Security Income Payments – Hardcopy Form	Form	Modified	Available
0960-0416 Supporting Statement.docx	Supporting Statement A	Uploaded 2016-04-28	Available
0416 Addendum.doc	Supplementary Document	Uploaded 2016-04-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37987	Statement for determining continuing eligibility for Supplemental Security Income Payments -- MISSIC Screens Signature Proxy	Other-Internal Use Screens	Modified
178984	Determining Continuing Eligibility for Supplemental Security Income Payments – Hardcopy Form	Form	Modified
178983	Statement for Determining Continuing Eligibility for Supplemental Security Income Payments –MISSIC Screens	Other-Internal Use Screens	Modified

ICR Details

OMB Control No: 0960-0416	ICR Reference No: 201601-0960-008
Status: Historical Active	Previous ICR Reference No: 201211-0960-003
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: 08/17/2016
	Date Received in OIRA: 04/28/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	08/31/2016
Responses	1,603,577	0	1,615,733
Time Burden (Hours)	523,418	0	525,627
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA uses the information collected on Form SSA-8203-BK for high-error-profile (HEP) redeterminations of disability to determine whether SSI recipients have met, and continue to meet, all statutory and regulatory requirements for SSI eligibility. SSA also uses the information to determine SSI recipients have been, and are still receiving, the correct SSI payment amount. Periodic collection of this information is the only way SSA can make these determinations, and collection of this information is mandatory under the law. The information is normally completed in field offices by personal contact (face-to-face or telephone interview) using the automated Modernized SSI Claim System (MSSICS). The respondents are SSI recipients or their representative payees.

---

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

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 6568	02/08/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 22698	04/18/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Statement for determining continuing eligibility for Supplemental Security Income Payments -- MISSIC Screens Signature Proxy
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments –MISSIC Screens
Determining Continuing Eligibility for Supplemental Security Income Payments – Hardcopy Form	SSA-8203	Statement Determining Continuing Eligibility for Supplemental Security Income Payments

---

ICR Summary of Burden

table that charts list 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	1,603,577	1,615,733	0	0	-12,156	0
Annual Time Burden (Hours)	523,418	525,627	0	0	-2,209	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The increase in burden hours stems from an increase in the number of paper redeterminations .

---

Annual Cost to Federal Government: $13,138,331

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

---

Common Form ICR:  No

---

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: 04/28/2016

---