The agency made substantial modifications to the supporting statement to provide greater detail regarding the burdens associated with this information collection. No later than one-year after deployment of this new instrument, the agency will offer OMB a briefing on the use of this form and any impacts to increased access to TI benefits and/or reductions in overpayments.
Inventory as of this Action
Requested
Previously Approved
06/30/2026
36 Months From Approved
06/30/2023
53,586
0
60,000
21,881
0
5,000
0
0
0
SSA collects this information to determine if institutionalized SSI recipients will only be in the institution or medical facility for three months maximum, and if they still need SSI payments. To do this, the recipient, the recipientâs representative payee, or if the recipient does not have a representative payee, someone on their behalf typically calls SSA to provide the statement of need, and a signed physicianâs certification is sent via mail. In addition, SSA employees upon finding out about a recipient entering an institution can contact the recipient or recipientâs representative payee to obtain the statement of need and a physician's certification. SSA accepts a certification or copy of a certification signed by the recipientâs physician, attesting to the period of confinement. SSA accepts a signed statement or a verbal confirmation from the recipient, or from the representative payee, acting on behalf of the recipient, about the need to maintain a home. In addition, SSA created an official form, the SSA-186, Temporary Institutionalization Statement to Maintain Household and Physician Certification, that collects the signature of the SSI recipient, provides the statement of need, and the physicianâs signature providing the physicianâs certification with the time period of confinement. The form asks the same questions that are on the SSI Claims System screens. The respondents are medical providers, and SSI recipients or their representative payees.
US Code:
42 USC 1382
Name of Law: Social Security Act
When we last cleared this collection in 2018, the burden was 5,000 hours. However, we are currently reporting a burden of 13,396 hours. This change stems from a decrease in the number of responses from 60,000 to 53,586, as well as an increase in burden time per response from 5 to 15 minutes. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.
* Note: The total burden reflected in ROCIS is 21,881, while the burden cited in #12 of the Supporting Statement is 13,396. This discrepancy is because the ROCIS burden reflects the following components: Teleservice Center waiting time. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.
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:
(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;
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.
Form SSA-186 Temporary Institutionalization Statement to Maintain Household and Physician Certification
Addendum - 0516 (Final).docx
Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Statement from other Respondents