Addendum to the Supporting Statement for 0960-0144

Addendum to the Supporting Statement for Form SSA-3441

Disability Report-Appeal

20 CFR 404.1512 & 416.912, 20 CFR, 404.916(c) & 416.1416(c), and 20 CFR 405, Subpart C & 20 CFR 422.140

0MB No. 0960-0144

Revision to the Collection Instrument

We expanded the wording of the question in Section 9 of the paper form to make the respondent more aware of the specific kinds of plans or programs we are asking about.

We restructured the information collected at the bottom of page 8 to eliminate duplicate information collection if the respondent is either the disabled person or the person identified in Section I Item D. The duplicate information eliminated is the respondent’s address. If the respondent is the disabled person, we will have already collected his or her address on the separate appeal request form. If the respondent is the person identified in Section I Item D., we will have already collected his or her address in Item D. We need to collect address information here only if the respondent is neither the disabled person nor the person identified in Section I Item D. This information enables us to contact the respondent by mail if we are unsuccessful in doing so by telephone (or email). We want to collect the respondent’s telephone number to permit a more expeditious contact with him or her if we need to clarify information on the form or obtain missing information. We also want to collect relationship information to enable us to determine if the respondent is a proper party who can protect the disabled person’s appeal request filing date.

Comparable changes will be made to both the Internet and EDCS screens.

Proposed Changes to Screening Questions Accompanying the Internet i3441 (iAppeals Program)

SSA has made the decision to support online completion of the request for appeal (Request for Reconsideration, or Request for Hearing by Administrative Law Judge) of medical denials, beginning September 30, 2007. The addition of the request for appeal to SSA’s online services has necessitated some changes to the screening questions accompanying the i3441. No questions within the i3441 are being modified in any way.

Currently, there are questions associated with the i3441 that direct the user to the correct appeal request. These screening questions will now be used to direct the user to the most appropriate appeal request for their purposes (i501 or i561). The i3441 introductory screens containing the questions will now appear as the screening questions for all of the appeals requests as a part of the iAppeals Program, and will no longer appear specifically for the i3441. Also, since the i3441 will be a part of the iAppeals Program, public access to the i3441 will be available only through the iAppeals Program and will not be accessible in any other way.

The specific changes that we are proposing are as follows:

Question	Current Screen Location	New Screen Location
#1: Do you live in the United States or one of its territories/ commonwealths?	i3441 ee005a ee005b	iAppeals “About Your Appeal”
#2: Did you receive a Notice of Decision?	i3441 ee005a ee005b	iAppeals “About Your Appeal”
#3: If yes, select notice title:	i3441 ee005a	Deleted – no longer needed
This Internet Disability Report Requires a Printer – entire screen	i3441 ee005b	Deleted – no longer needed
#4: What is your Social Security number?	i3441 ee006a ee006b	iAppeals “Should You Use This Internet Appeal Process?”
#5: What is your date of birth?	i3441 ee006a ee006b	iAppeals “Should You Use This Internet Appeal Process?”
#6: Do you have access to a working printer for your computer?	i3441 ee006a	Deleted – No longer needed
#7: What is the date on the notice you received?	i3441 ee006a ee006b	iAppeals “Should You Use This Internet Appeal Process?” screen
#8: Have you sent an appeal form to us since you received your "Notice of Decision"?	i3441 ee006a ee006b	Deleted – no longer needed
#9: Contact Us to Get the Request for Appeal – entire screen	I3441 rs007gen	Deleted – no longer needed
#10: Print the Request for Reconsideration Form – entire screen	rs007rc	Deleted – no longer needed
#11: Print the Request for Hearing Form – entire screen	rs007hr	Deleted – no longer needed
#12: Print the Request for Reconsideration – Disability Cessation Form – entire screen	rs007fr	Deleted – no longer needed