Continuation of Supplemental Security Income Payments for the Temporarily Institutionalized – Certification of Period and Need to Maintain Home

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-186 Temporary Institutionalization Statement to Maintain Household and Physician Certification	Form	Modified	Available
Form SSA-186 Temporary Institutionalization Statement to Maintain Household and Physician Certification	Form and Instruction	Modified	Available
Addendum - 0034 (Final).docx	Supplementary Document	Uploaded 2026-06-26	Available
Supporting Statement - 0516 (Final).docx	Supporting Statement A	Uploaded 2026-06-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9422	Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Statement from other Respondents	Form	Modified	Temporary Institutionalization Statement to Maintain Household and Physician Certification
9422	Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Statement from other Respondents	Other-SSI Claims System Screens	Modified
260647	Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Physician's Certifications	Form and Instruction	Modified	Temporary Institutionalization Statement to Maintain Household and Physician Certification
260647	Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Physician's Certifications	Other-Intranet Screens	Modified

ICR Details

OMB Control No: 0960-0516	ICR Reference No: 202606-0960-001
Status: Received in OIRA	Previous ICR Reference No: 202105-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Continuation of Supplemental Security Income Payments for the Temporarily Institutionalized – Certification of Period and Need to Maintain Home
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/26/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	53,424	53,586
Time Burden (Hours)	34,726	21,881
Cost Burden (Dollars)	0	0

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Abstract: When SSI recipients: (1) enter a public institution; or (2) enter a private medical treatment facility with Medicaid paying more than 50 percent of expenses, SSA reduces recipients’ SSI payments to a nominal sum. However, if this institutionalization is temporary (defined as a maximum of three months), SSA may waive the reduction. Before SSA can waive the SSI payment reduction, the agency must receive the following documentation: (1) A physician’s certification stating the SSI recipient will only be institutionalized for a maximum of three months; and (2) statement from the recipient (or someone knowledgeable about the recipient’s circumstances, such as a representative payee, family member, or friend), confirming the recipient needs SSI payments to maintain the living arrangements to which the individual will return post institutionalization. To obtain this information, SSA employees contact the recipient (or a knowledgeable source) to collect the required physician’s certification and the statement of need. SSA does not require any specific format for these items, so long as we obtain the necessary attestations; however, SSA allows the use of Form SSA-186 as a convenient way to notify SSA, request continued benefits, and obtain physician certification on one document. The respondents are SSI recipients or individuals with knowledge of their circumstances such as representative payees, family members, or friends, as well as physicians or hospital staff members who treat the SSI recipient.

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Authorizing Statute(s): US Code: 42 USC 1382 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 22569	04/27/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 38748	06/26/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Physician's Certifications	SSA-186	Temporary Institutionalization Statement to Maintain Household and Physician Certification
Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Statement from other Respondents	SSA-186	Temporary Institutionalization Statement to Maintain Household and Physician Certification

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	53,424	53,586	0	0	-162	0
Annual Time Burden (Hours)	34,726	21,881	0	0	12,845	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: When we cleared this ICR in 2023, the burden was 13,396 hours. However, we are currently reporting a burden of 13,356 hours. The decrease in burden is due to a decrease in the number of responses from 53,586 to 53,424. These figures represent current Management Information data. *Note: The total burden reflected in ROCIS is 34,726 while the burden cited in #12 of the Supporting Statement is 13,356. This discrepancy is because the ROCIS burden reflects the telephone call system wait times. In contrast, the chart in #12 above reflects actual burden.

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Annual Cost to Federal Government: $212,068

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.     No

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.     No

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? No

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Common Form ICR:  No

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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: 06/26/2026

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