Justification for the Non-Substantive Changes for 0960-0444

Justification for Non-Substantive Changes for Form SSA-8001-BK

Application for Supplemental Security Income

20 CFR 416.305 - 20 CFR 416.335, Subpart C

OMB No. 0960-0444

Background

The Social Security Administration (SSA) uses Form SSA-8001-BK to determine an applicant’s eligibility for Supplemental Security Income (SSI), and the SSI payment amounts. SSA employees also collect this information during interviews with members of the public who wish to file for SSI. SSA uses the information on Form SSA-8001-BK to formally deny SSI for non-medical reasons when information the applicant provides results in ineligibility; or to establish a disability claim, but defer the complete development of non-medical issues until SSA approves the disability. Currently, an SSA employee can fill out the SSA-8001-BK form in a phone interview or through a face-to-face interview. At this time, SSA employee must print the blank PDF and fill it out using a pen, or they need to use a typewriter to complete the form. As some handwriting is difficult to read, or illegible, these non-fillable versions of the form are inefficient and ineffective. Since other SSA employees who cannot read the submitted form must verify the information prior to processing. In addition, the use of typewriters decreased significantly, as other tools, such as personal computing devices, increase in use.

SSA developed a fillable, printable version of the SSA-8001-BK, as some individuals may find it easier to use. The fillable version allows the SSA employees to complete the form electronically using a personal computer, or other computing device and print the completed form. We developed this fillable version, as we want to ensure SSA provides effective communication and remains in compliance with the requirements of 45 CFR 85.51 of the Code of Federal Regulations and section 504 of the Rehabilitation Act of 1973. We propose the fillable PDF version as a more accessible modality. In addition, the new fillable modality will enhance our electronic services and recordkeeping efforts.

Revisions to the Information Collection

• Change #1: SSA intends to provide Form SSA-8001-BK 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 #1: This change will allow the SSA employees 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 process the form.

After OMB approves the addition of the new fillable version of the form, SSA will phase out the standard PDF versions from our Intranet website and replace them with the fillable PDF file. This action does not affect the public reporting burden.