Supporting Statement for Form SSA-3881-BK
Questionnaire for Children Claiming SSI Benefits
20 CFR 416.912(a)
A. Justification
Introduction/Authoring Laws and Regulations
Section 1614 and Section 1631(e)(1) of the Social Security Act (Act) gives the agency the authority to collect the information we need to determine the validity of an applicant’s claim for Supplemental Security Income (SSI) payments. Public Law 104-193, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, gives the definitions and eligibility rules for disabled children. Section 20 CFR 416.912(a) of the Code of Federal Regulations states that an applicant must furnish medical and other evidence, which SSA can use to reach conclusions about a child’s medical condition.
Description of Collection
Parents or legal guardians seeking to obtain or retain SSI eligibility for their children use Form SSA-3881-BK to provide SSA with the addresses of non‑medical sources such as schools, counselors, agencies, organizations, or therapists who have information about a child’s function. SSA uses this information to help determine a child’s claim or continuing eligibility for SSI. The respondents are applicants who appeal SSI childhood disability decisions or recipients undergoing a continuing disability review.
Use of Information Technology to Collect the Information
In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an electronic version of Form SSA-3881-BK. Based on our data, we estimate approximately 35% of respondents under this OMB number use the electronic version.
Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it preclude duplication. SSA does not use any other collection instrument to collect similar data.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-3881-BK, we would have no means of ensuring that: (1) our initial denials of child applicants for SSI were correct; or (2) our determinations for continuing eligibility for child SSI payments are accurate. Because we collect this information on an as needed basis, we cannot collect it less frequently. There are no technical or legal obstacles to burden reduction.
Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on February 21, 2017, at
82 FR 11293, and we received no public comments. SSA published the second Notice on April 26, 2017, at 82 FR 19304. If we receive any comments in response to this Notice, we will forward them to OMB.
Payment or Gifts to Respondents
SSA does not provide payment or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates
of Public Reporting Burden
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden per Response (minutes) |
Estimated Total Annual Burden (hours) |
Paper Version |
84,500 |
1 |
30 |
42,250 |
Intranet Version (EDCS) |
45,500 |
1 |
30 |
22,750 |
Total |
130,000 |
|
|
65,000 |
The total burden for this ICR is 65,000 hours. This figure represents burden hours, and we did not calculate a separate cost burden.
Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government for Form SSA-3881-BK is approximately $15,701. This estimate is a projection of the costs for printing and distributing the collection instrument, and for collecting the information.
Program Changes or Adjustments to the Information Collection Request
The increase in burden hours stems from SSA conducting more continuing disability reviews.
Plans for Publication Information Collection Results
SSA will not publish the results of this information collection.
Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | October 1997 |
| Author | 505969 |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |