Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-2930 RSI/DI Quality Review Case Analysis - Sampled Number Holder	Form	Unchanged	Available
Form SSA-8510 Authorization For The Social Security Administration To Obtain Personal Information	Form	Unchanged	Available
Form SSA-2935 Authorization to the Social Security Administration to Obtain Personal Informaition	Form and Instruction	Unchanged	Available
Form SSA-85 Information Needed to Review Your Social Security Claim	Form	Modified	Available
Form SSA-8552 Interview Confirmation	Form	Unchanged	Available
Form SSA-4659 Stewardship Annual Earnings Test Workbook	Form	Unchanged	Available
Form SSA-2931 RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors	Form	Unchanged	Available
Justification for a Non-Substantive Changes - 0189.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-07-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9153	SSA-2930	Form	Unchanged	RSI/DI Quality Review Case Analysis - Sampled Number Holder
195245	SSA-8510	Form	Unchanged	Authorization For The Social Security Administration To Obtain Personal Information
183776	SSA-2935	Form and Instruction	Unchanged	Authorization to the Social Security Administration to Obtain Personal Informaition
183776	SSA-2935	Other-Revised PA Statement	Unchanged
183775	SSA-85	Form	Modified	Information Needed to Review Your Social Security Claim
183774	SSA-8552	Form	Unchanged	Interview Confirmation
183773	SSA-L8554-U3	Other-Notice	Modified
183772	SSA-L8553-U3	Other-Notice	Modified
183771	SSA-L8552-U3	Other-Notice	Unchanged
183770	SSA-L8551-U3	Other-Notice	Unchanged
183769	SSA-L8550-U3	Other-Notice	Unchanged
183268	SSA-4659	Form	Unchanged	Stewardship Annual Earnings Test Workbook
183268	SSA-4659	Other-Revised PA Statement	Unchanged
183264	SSA-2931	Form	Unchanged	RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors

ICR Details

OMB Control No: 0960-0189	ICR Reference No: 201807-0960-008
Status: Historical Active	Previous ICR Reference No: 201703-0960-010
Agency/Subagency: SSA	Agency Tracking No:
Title: Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/27/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/20/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	10/31/2020	10/31/2020
Responses	18,215	0	18,215
Time Burden (Hours)	2,525	0	2,525
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 205(a) of the Social Security Act (Act) authorizes the Commissioner of SSA to conduct the quality review process, which entails collecting information related to the accuracy of payments made under the Old-Age, Survivors, and Disability Insurance Program (OASDI). Sections 228(a)(3), 1614(a)(1)(B), and 1836(2) of the Act require a determination of the citizenship or alien status of the beneficiary; this is only one item that we might question as part of the Annual Quality review. SSA uses Forms SSA-2930, SSA-2931, and SSA-2932 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 Survivors Insurance (RSI) and Disability Insurance (DI) programs. We also use the information to measure the accuracy rate for newly adjudicated RSI or DI cases. SSA uses Form SSA-4659 to evaluate the effectiveness of the annual earnings test, and to use the results in developing ongoing improvements in the process. About twenty-five percent of respondents will have in-person reviews and receive one of the following appointment letters: (1) SSA-L8550-U3 (Appointment Letter – Sample Individual); (2) SSA-L8551-U3 (Appointment Letter – Sample Family); or (3) the SSA-L8552-U3 (Appointment Letter – Rep Payee). Seventy-five percent of respondents will receive a notice for a telephone review using the SSA-L8553-U3 (Beneficiary Telephone Contact) or the SSA-L8554-U3 (Rep Payee Telephone Contact). To help the beneficiary prepare for the interview, we include three forms with each notice: (1) SSA-85 (Information Needed to Review Your Social Security Claim) lists the information the beneficiary will need to gather for the interview; (2) SSA-2935 (Authorization to the Social Security Administration to Obtain Personal Information) verifies the beneficiary’s correct payment amount, if necessary; and (3) SSA-8552 (Interview Confirmation) confirms or reschedules the interview if necessary. The respondents are a statistically valid sample of all OASDI beneficiaries in current pay status or their representative payees. This is a Change Request to make minor revisions to two forms, and upload the correct revised version of the SSA-85 which OMB approved in 2017.

---

Authorizing Statute(s): US Code: 42 USC 1382c Name of Law: Social Security Act
   US Code: 42 USC 428 Name of Law: Social Security Act
   US Code: 42 USC 1395o Name of Law: Social Security Act
   US Code: 42 USC 405 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:
	82 FR 15412	03/28/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 32431	07/13/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
SSA-2930	SSA-2930	RSI/DI Quality Review Case Analysis - Sampled Number Holder
SSA-2931	SSA-2931	RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors
SSA-2935	SSA-2935	Authorization to the Social Security Administration to Obtain Personal Informaition
SSA-4659	SSA-4659	Stewardship Annual Earnings Test Workbook
SSA-85	SSA-85	Information Needed to Review Your Social Security Claim
SSA-8510	SSA-8510	Authorization For The Social Security Administration To Obtain Personal Information
SSA-8552	SSA-8552	Interview Confirmation
SSA-L8550-U3
SSA-L8551-U3
SSA-L8552-U3
SSA-L8553-U3
SSA-L8554-U3

---

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	18,215	18,215	0	0	0	0
Annual Time Burden (Hours)	2,525	2,525	0	0	0	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:

---

Annual Cost to Federal Government: $3,317

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 07/20/2018

---