Addendum to the Supporting Statement for 0960-0189

Addendum to Supporting Statement for

RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors,

SSA-L8553-U3 (Beneficiary Telephone Contact),

SSA-L8554-U3 (Representative Payee Telephone Contact)

OMB: 0960-0189

Background

The Social Security Administration (SSA) uses Forms SSA-2930 and SSA-2931 to establish a national payment accuracy rate for all cases in payment status, and to serve as a source of information regarding problem areas in the Retirement and Survivors Insurance (RSI) and Disability Insurance (DI) programs. We also use the information to measure the accuracy rate for newly adjudicated RSI/DI cases.

We collect all of the information on these forms through personal telephone interviews with the beneficiaries. An SSA employee conducts the interviews, and writes the respondents’ answers to the questions directly on the appropriate paper form.

We send respondents a notice for a telephone contact review using either the SSA‑L8553-U3 (Beneficiary Telephone Contact) or the SSA-L8554-U3 (Representative Payee Telephone Contact).

Revisions to the Collection Instruments

SSA is making the following revisions:

SSA-2930-BK

• Change #1: We are making changes to the SSA-2930-BK – RSI/DI Quality Review Case Analysis – Sampled Number Holder (interview workbook) to remove all Face‑To-Face language, and replacing it with “Telephone Review.”

Justification #1: We are removing the face-to-face language on this form from page 2, Section I and from the header on page 3, 5, 7, 9, 11, 13, 15, 17, and 19. OQR no longer completes reviews using face-to-face contact. The header on the pages should read “Telephone Review,” as that is the only way we contact the respondents.

SSA-2931-BK

• Change #2: We are making changes to the SSA-2931-BK – RSI/DI Quality Review Case Analysis – Auxiliaries/Survivors (interview workbook) to remove all Face‑to‑Face language, and replacing it with “Telephone Review.”

Justification #2: We are removing the face-to-face language on this form from page 1 and from the header on pages 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25 27, 29 31, 33, and 35. OQR no longer completes reviews using face-to-face contact. The headers should read “Telephone Review,” as that is the only way we contact the respondents.

• Change #3: We are reformatting Form SSA-2931 to include space for a fourth beneficiary’s identification on the 1^st page.

Justification #3: We are adding these additional fields to accommodate cases where we must record information for more than 3 beneficiaries as part of our review.

• Change #4: We are adding fields on page 10 of the SSA-2931 as follows:

From:

E. Multiple Entitlement Involved: [ ] Yes [ ] No

1. Claim Number on Non-sampled SSN: XXX-XX-XXXX

2. Scope of Review on Non-sampled SSN:

[ ] Full Review [ ] Limited Review [ ] Not in Scope of Review

To:

E. Multiple Entitlement Involved: [ ] Yes (complete below) [ ] No

1. Claim Number on [ ] Non-sampled SSN [ ] Sampled SSN XXX-XX-XXXX

2. Scope of Review on [ ] Non-sampled SSN [ ] Sampled SSN

[ ] Full Review [ ] Limited Review [ ] Not in Scope of Review

Justification #4: We are making these changes to gather information requested on the non-sampled SSN.

• Change #5: We are extending the space in the fields on page 22 to record parents’ names.

Justification #5: To input the parent’s name, we need to extend space in the fields for 1B, 2B, 3B and 4B for the mother’s name (MN) and father’s name (FN).

SSA-L8553-U3 and SSA0-8554-U3

• Change #6: We are revising the SSA-L8553-U3 (Appointment Letter - Beneficiary Telephone Contact); and SSA-L8554-U3 (Representative Payee Telephone Contact) letters to add a list of our standard enclosures (Forms SSA-8552, SSA-2935-U3 and SSA-85).

Justification #6: We are adding this list of standard enclosures to the appointment letter to clarify which items came with the letter so the respondent will know which ones to return.

SSA-8552

• Change #7: We are removing all “visit” language from the SSA-8552 (Interview Confirmation), and changing the language to state “telephone interview.”

Justification #7: OQR no longer conducts visits (face-to-face contacts), rather we conduct telephone interviews only.

SSA-85, SSA-2930, SSA-2931, SSA-2935, SSA-4659, and SSA-8552

• Change #8: We are revising the Privacy Act Statement on Forms SSA-85, SSA‑2930, SSA-2931, SSA-2935, SSA-4659, and SSA-8552.

Justification #8: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on these forms.