Supporting Statement - 0744

Supporting Statement for the SSA-372

Request for Reinstatement (Title XVI)

20 CFR 416.999 - 416.999d

OMB #0960-NEW

A. Justification

1. Introduction/Authoring Laws and Regulations

Section 112 of Public Law 106-170, the Ticket to Work and Work Incentives Improvement Act of 1999, added Section 1631(p) to the Social Security Act to allow certain previously entitled individuals to request expedited reinstatement (EXR) of those disability benefits under Title XVI when their medical condition no longer permits them to perform substantial gainful activity (SGA). 20 CFR 416.999 through 20 CFR 416.999d in the Code of Federal Regulations and in 42 USC 1383 of the United States Code further describe the rules for EXR.

2. Description of Collection

SSA uses the SSA-372 to obtain a signed statement from individuals stating a request for Expedited Reinstatement (EXR) of their Title XVI Supplemental Security Income (SSI) payments, and to prove that the requestor meets the EXR requirements. SSA also uses this collection to ensure that we explain the EXR requirements to the respondent; therefore, we use it as part of the application process. We maintain the form in the disability folder of the applicant to demonstrate the individual’s awareness of the EXR requirements and their choice to request EXR. Respondents are individuals requesting expedited reinstatement of their Title XVI SSI payments

2. Use of Information Technology to Collect the Information

Currently, SSA does not collect this information electronically and respondents must complete the paper form manually. At this time, SSA has no plan to collect this information electronically, as the EXR poses a relatively small workload and has no automated system. Since other, higher volume forms take precedence to low volume forms such as the SSA-372, SSA needs to prioritize those higher volume forms for electronic conversion.

2. Why We Cannot Use Duplicate Information

The nature of the information collected and the manner in which it is collected preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.

2. Minimizing Burden on Small Respondents

This collection does not affect small businesses or other small entities.

2. Consequence of Not Collecting Information or Collecting it Less Frequently

If SSA did not collect this information we could not ensure that individuals requesting EXR are aware of the requirements and that they have made the choice to request EXR. Also, because we only collect this information on an as needed basis, SSA cannot collect it less frequently. There are no technical or legal obstacles that prevent burden reduction.

2. Special Circumstances

There are no special circumstances that would cause SSA to conduct this information collection in a manner that is not consistent with 5 CFR 1320.5.

2. Solicitation of Public Comment and Other Consultations with the Public

The 60-day advance Federal Register Notice published on October 6, 2009 at 74 FR 51353, and SSA has received no public comments. The second Notice published on December 8, 2009, at 74 FR 64801. There have been no outside consultations with members of the public.

2. Payment or Gifts to Respondents

SSA provides no payment or gifts to the respondents.

2. Assurances of Confidentiality

The information provided on this form is protected and held confidential in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.

2. Justification for Sensitive Questions

The information collection does not contain any questions of a sensitive nature.

2. Estimates of Public Reporting Burden

Approximately 2,000 respondents take 2 minutes each to complete form SSA-372 each year for a total of 67 burden hours. This figure represents burden hours, and we did not calculate a separate cost burden.

2. Annual Cost to the Respondents (Other)

There is no known cost burden to the respondents.

2. Annual Cost To Federal Government

The annual cost to the Federal Government is approximately $4,620. This estimate is a projection of the costs for printing and distributing the collection instrument, for collecting the information.

2. Program Changes or Adjustments to the Information Collection Request

There are no changes to the public reporting burden.

2. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

2. Displaying the OMB Approval Expiration Date

OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.

2. Exceptions to Certification Statement

SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3)

B. Collections of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.