Addendum to the Supporting Statement 0960-0773

Addendum to the Supporting Statement for

Medicare Modernization Act Outreach Program

Form SSA-1023

OMB No. 0960-0773

Removal of Collection Instrument

We are removing the automated follow-up telephone call (Medicare Automated Reminder System Message) as a collection instrument. We incorrectly reported a burden for this activity when we last cleared this ICR. This activity is a pre-recorded, automated telephone message played to respondents. There is no public burden associated with this activity.

Below is the text of the recording of the automated telephone call played to beneficiaries who requested form SSA-1020 via the MMA Outreach Mailing Insert (SSA-1023) but did not return the completed form:

“We are calling to follow up on a letter you should have received recently from Social Security about extra help with prescription drug costs. If you think you may qualify, please fill out and return the application enclosed with the letter or file online at www.socialsecurity.gov. If you have questions or need help, please call Social Security’s toll free number, 1-800-772-1213.”

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.

SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the first page of the form.