Statement for Determining Continuing Eligibility for Supplemental Security Income Payments

Forms and Documents

Document Name	Status
Form SSA-8203 Determining Continuing Eligibility for Supplemental Security Income Payments – Hardcopy Form Form	Modified
Addendum - 0416.doc Supplementary Document	2009-12-29
Supporting Statement - 0416.doc Supporting Statement A	2010-01-27

IC Document Collections

IC ID	Document Title	Status
37987	Statement for determining continuing eligibility for Supplemental Security Income Payments -- MISSIC Screens Signature Proxy Other-Internal Use Screens	Modified
178984	Determining Continuing Eligibility for Supplemental Security Income Payments – Hardcopy Form Form	Modified
178983	Statement for Determining Continuing Eligibility for Supplemental Security Income Payments –MISSIC Screens Other-Internal Use Screens	Modified

ICR Details

OMB Control No: 0960-0416	ICR Reference No: 200910-0960-006
Status: Historical Active	Previous ICR Reference No: 200805-0960-020
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement for Determining Continuing Eligibility for Supplemental Security Income Payments
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/20/2010
	Date Received in OIRA: 01/28/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2013	36 Months From Approved	05/31/2010
Responses	157,612	0	171,000
Time Burden (Hours)	52,012	0	56,394
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses the information collected on form SSA-8203-BK for high-error-profile (HEP) redeterminations of disability to determine whether SSI recipients have met and continue to meet all statutory and regulatory requirements for SSI eligibility and whether they have been, and are still receiving, the correct payment amount. Periodic collection of this information is the only way SSA can make these determinations, and collection of this information is mandatory under the law. The information is normally completed in field offices by personal contact (face-to-face or telephone interview) using the automated Modernized SSI Claim System (MSSICS). The respondents are SSI recipients or their representative payees.

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Authorizing Statute(s): US Code: 42 USC 1382a 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:
	74 FR 59336	11/17/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 3778	01/22/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Statement for determining continuing eligibility for Supplemental Security Income Payments -- MISSIC Screens Signature Proxy
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments –MISSIC Screens
Determining Continuing Eligibility for Supplemental Security Income Payments – Hardcopy Form	SSA-8203	Statement Determining Continuing Eligibility for Supplemental Security Income Payments

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ICR Summary 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	157,612	171,000	0	0	-13,388	0
Annual Time Burden (Hours)	52,012	56,394	0	0	-4,382	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: The 4,382 hour decrease in the public reporting burden reflects the selection of fewer redeterminations profiled due to SSA’s reduced budget.

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Annual Cost to Federal Government: $7,000,000

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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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: 01/28/2010

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