Addendum to Supporting 0618

Addendum to the Supporting Statement for Social Security Benefits Application:

Form SSA-1: Application for Retirement Insurance Benefits

Form SSA-2: Application for Wife’s or Husband’s Insurance Benefits

Form SSA-16: Application for Disability Insurance Benefits

Internet Claim (iClaim) Application Screens

20 CFR 404.310-404.311, 404.315-404.322, 404.330-404.333, 404.601-404.603, and 404.1501-404.1512

OMB No. 0960-0618

Revision to the Collection Instrument

Changes to iClaim

This addendum summarizes the changes to iClaim’s functionality and screens. The attached file contains iClaim screen shots that reflect these changes.

We are adding a new functionality to iClaim that will allow qualified individuals the ability to submit an online application for both Social Security and Supplemental Security Income (SSI) disability benefits. When an individual is answering the disability benefit questions in iClaim, they will receive a question regarding their intent to file for SSI. For a qualified individual whose response is “yes,” iClaim will become an application for both Social Security and SSI disability benefits.

With this first release, the SSI application will consist of questions common to both disability applications, SSA-16 (covered under this information collection request) and the SSA-8001 (covered under OMB No. 0960-0444) as well as one additional question from the SSI application (SSA-8001) about household members to present the correct Supplemental Nutrition Assistance Program (SNAP) filing information. Although we are not adding all the SSI application questions to iClaim, we are collecting enough information to establish a deferred application in MSSICS and obtain a medical determination from the DDS providing the claimant is technically eligible for Title II disability. An iClaim disability application that also includes an SSI application will provide messages that contain information on filing an application for benefits under the Supplemental Nutrition Assistance Program (SNAP). The online SSI application responses will populate to the corresponding screens in the Modernized SSI Claims System (MSSICS) creating an unsigned SSI deferred claim.

Once the Department of Disability Services (DDS) approves the claim, the field office (FO) will collect the remaining SSI questions via field office interviews to determine payment eligibility and benefit amount (covered under OMB No. 0960-0444, as we will use the current MSSICS screens for the SSA-8001 to collect the additional information). If the DDS denies the claim, the FO will be able to process the denial through MSSICS without addressing the remaining SSI application questions because benefit eligibility is no longer a factor. For situations where the Title II claim is not sent to the DDS for a medical determination (e.g. does not meet insured status), the FO will contact the claimant to collect the remaining SSI application questions prior to sending the SSI claim to the DDS for a medical determination.

In addition, we are removing the ability to complete an iClaim application in Spanish and adding a link to iAppointment for individuals who start an iClaim application and answer “Spanish” or any other non-English language, to the question regarding their preferred language for reading. This will provide the option to apply for benefits in another language.

Below is a summary of changes and additions for the revised iClaim screens:

• Change 1: We are updating the Privacy Act (PA) Statement on the Welcome page. (See Modified Screen #1A and #1B).

Justification 1: Currently, the iClaim PA statement only covers Title II applications. Because we are adding a Title XVI (SSI) disability application to iClaim, we needed a PA statement that covers both titles.

• Change 2: The Contact Information page is located at the beginning of the iClaim and collects information regarding the claimant’s language preferences. When the preferred language for reading is other than English, a new message will appear that explains additional filing options (e.g. field office interview). If the individual is not banned from visiting a field office, iClaim presents three options: (1) Continue Application; (2) Schedule an Appointment (link to iAPPT); and (3) Exit (See Modified Screen #2A). Individuals banned from the field office would need to call the 800# to schedule an appointment. They do not have the option to go to iAPPT (See Modified Screen #2) when a user selects a language other than English as their preferred language for reading.

Justification 2: We are adding this message so claimants who are not comfortable completing the iClaim in English can instead schedule an appointment or contact SSA to apply for benefits in another language.

• Change 3: On the Re-entry Number page, for first party applicants only, we are replacing the current language that explains how a user will need to start another iClaim if they lose their

re-entry number with language that explains how to obtain their lost or forgotten re-entry number. We are revising the language located under the heading “Things you should know about your application.” Specifically we are removing language that speaks to the inability to file an online SSI application and revising SSI’s closeout language. (See Modified Screen #3A for first party language and Modified Screen #3B for the third party language).

Justification 3: The re-entry language does not reflect current system enhancements. Previously if a first party applicant lost or forgot their re-entry number they would have to start a new iClaim. Due to recent system enhancements, a first party applicant can recover their

re-entry number by accessing or creating a my Social Security account. At this point of the application process, we are unable to fully determine if the applicant meets the conditions to include an SSI application with their disability application, so we removed the language that reads, “You cannot apply for SSI over the Internet.” We modified the closeout language for both titles for consistency.

• Change 4: On the Benefit Information page, we are removing the question “Have you recently applied for SSI?” and adding the SSI question, “Is everyone in your household receiving or applying for Supplemental Security Income?” when required. We are also adding a SNAP message with language that is determined by the resident address and the SSI household response as follows: (1) CA residence (See Modified Screen #4A and #4B); (2) non-CA resident, and “yes” to the SSI household question (See Modified Screen #4C and #4D); and (3) non-CA resident, and “no” to the SSI household question (See Modified Screen #4E and #4F). We are adding OMB No. 0960-0444 with the links to the corresponding Paperwork Reduction Act Statement and Privacy Act Statements for SSI to this screen (See modified Screen # 10).

Justification 4: We do not need to ask the applicant if they recently applied before because we capture this information at the time the user starts an iClaim application through a utility that checks for any previous SSI claims. We are adding the SNAP question, as SSA’s contract with the USDA requires field offices to provide benefit and filing information for SNAP when an individual files an SSI application. Including the SSI household question along with the messages for SSI applicants ensures SSA’s compliance with this contract. Because we are adding the SSI household question from the SSA-8001 (SSI application) to this page, we are adding the OMB No. 0960-0444 and Paperwork Reduction Act link associated with the SSA‑8001 to this screen.

• Change 5: We are updating the Overall Summary page to include the SSI question with response from the Benefit Information page (See Modified Screen #5).

Justification 5: The Overall Summary page provides all the questions and responses for the applicant to review before signing and submitting their application. Since we added a new SSI question to iClaim, we need to include the question and response on the Overall Summary page.

• Change 6: We are updating the language for the Electronic Signature agreement to include the language required when filing for SSI. This language additional language will only be included when an SSI application is included in iClaim (See Modified Screen #6).

Justification 6: Currently the language for the Electronic Signature Agreement refers only to a Social Security disability application. With the addition of the SSI application, we needed to include language for the SSI application.

• Change 7: Applicants who file for retirement insurance benefits (RIB) using iClaim and answer “yes” to the question regarding their intent to file for SSI are not eligible to include an SSI application with their retirement claim. After submitting their iClaim the What’s Next Page will come into the iClaim path. We revised the SSI closeout language by removing the sentence that reads, “You cannot apply for SSI over the Internet” and modifying the remaining language to reflect the closeout language presented throughout iClaim. (See Modified Screen #7)

Justification 7: We made the changes so the language is consistent with the other closeout language provided throughout iClaim.

• Change 8: Applicants who save and exit an iClaim application will receive a new message that provides the re-entry number along with instructions for retrieving a lost or forgotten number. The message also explains that completing the application at a later date may affect the month their benefits will start and provides closeout language for both Title II and Title XVI. The applicant has the option to select the “Save and Exit” button or “Return to Application” button (See Modified Screen # 8A and #8B).

Justification 8: The closeout period for Title XVI is 60 days versus six months for Title II. Because the Title XVI closeout period is much shorter than the Title II, we added this reminder to ensure applicants are aware of the specific timeframe they have to apply.

• Change 9: We are adding a new screen to iClaim that displays the SSI closeout language for disability applicants who want to file for SSI but do not meet the conditions to include an SSI application with their disability application. The screen will display after selecting the “Accept & Continue to Step 2” button on the Overall Summary page. A “Next” button is located at the bottom of the page for the applicant to select which will take them to the i3368 OMB No. 0960-0579 (See Modified Screen #9).

Justification 9: Currently, after selecting the “Accept & Continue to Step 2” button the i3368 comes into the iClaim path for the applicant to complete. The applicant may save and exit out of the i3368 throughout the six-month closeout period for Title II. Since the Title XVI closeout period is 60 days, we wanted to remind the applicant of the timeframe they have to file the SSI application before losing benefits.

Revisions to the SSA-1-BK

• Change 10: Page 5, Question 26. We are adding a sentence.

• From:

DO NOT ANSWER ITEM 26 IF YOU ARE FULL RETIREMENT AGE AND 6 MONTHS OR OLDER. GO TO ITEM 27.

PLEASE READ CAREFULLY THE INFORMATION ON THE BOTTOM OF PAGE 8 AND ANSWER ONE OF THE

FOLLOWING ITEMS:

26. (a) I want benefits beginning with the earliest possible month, and will accept an age-related reduction.

(b) I am full retirement age (or will be within 12 months), and want benefits beginning with the earliest possible

month providing there is no permanent reduction in my ongoing monthly benefits.

(c) I want benefits beginning with ­­­­­­_____________.

• To:

DO NOT ANSWER ITEM 26 IF YOU ARE FULL RETIREMENT AGE AND 6 MONTHS OR OLDER. You may have more filing options; a Social Security representative will contact you to discuss additional information that may help you decide when to start your benefit. GO TO ITEM 27.

PLEASE READ CAREFULLY THE INFORMATION ON THE BOTTOM OF PAGE 8 AND ANSWER ONE OF THE

FOLLOWING ITEMS:

26. (a) I want benefits beginning with the earliest possible month, and will accept an age-related reduction.

(b) I am full retirement age (or will be within 12 months), and want benefits beginning with the earliest possible

month providing there is no permanent reduction in my ongoing monthly benefits.

(c) I want benefits beginning with ­­­­­­_____________.

Justification 10: We added language to inform a claimant who is full retirement age and 6 months or older that he or she may have more options and that a representative will contact him or her to discuss. This will not change the way the respondent completes the form.

• Change 11: Page 8: CHANGES TO BE REPORTED AND HOW TO REPORT; we are adding additional language:

• From:

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE YOU ANSWER QUESTION 26.

• If you are under full retirement age, retirement benefits cannot be payable to you for any month before the month

in which you file your claim.

• If you are over full retirement age, retirement benefits may be payable to you for some months before the month in

which you file this claim.

• If your first month of entitlement is prior to full retirement age, your benefit rate will be reduced. However, if you do

not actually receive your full benefit amount for one or more months before full retirement age because benefits are

withheld due to your earnings, your benefit will be increased at full retirement age to give credit for this withholding.

Thus, your benefit amount at full retirement age will be reduced only if you receive one or more full benefit

payments prior to the month you attain full retirement age.

• To:

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE YOU ANSWER QUESTION 26.

• If you are under full retirement age, retirement benefits cannot be payable to you for any month before the month

in which you file your claim.

• If you are over full retirement age, retirement benefits may be payable to you for some months before the month in

which you file this claim.

• If your first month of entitlement is prior to full retirement age, your benefit rate will be reduced. However, if you do

not actually receive your full benefit amount for one or more months before full retirement age because benefits are

withheld due to your earnings, your benefit will be increased at full retirement age to give credit for this withholding.

Thus, your benefit amount at full retirement age will be reduced only if you receive one or more full benefit

payments prior to the month you attain full retirement age.

• Delayed retirement credits may be added to your benefits if you request them to start when you are full retirement age or older.

• Please visit our www.ssa.gov web site to use the Retirement Estimator to get a personal estimate of how much your benefits will be at different ages. In addition, our web site provides information about other things you should think about when you make your decision about when to begin your benefits.

Justification 11: We added language to inform the claimants they can earn delayed retirement credits if benefits start at full retirement age or older, and to provide a link to our website where the claimant can access the Retirement Estimator and get information about other things that will help in deciding when to start receiving benefits.

• Change 12: SSA intends to provide Form SSA-1 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 12: 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. This action does not affect the public reporting burden.

Upon OMB approval 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.

Revision to the SSA-1-INST

• Change 13: Page 1, left column, bullet 7; we are removing the bullet:

• You become entitled to a pension or annuity based on your employment not covered by Social Security, or if such pension or annuity stops.

Justification 13: We removed the bullet as duplicate language appears on page 1, left column, bullet 10.

Revision to the SSA-2-BK

• Change 14: SSA intends to provide Form SSA-2 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 14: 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.