Template - Social Security Statement Telephone Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0960-0788)

TITLE OF INFORMATION COLLECTION: Social Security Statement Telephone Survey

PURPOSE: The Social Security Administration (SSA) is required by law to provide annual benefits and earnings statements to Social Security number-holders age 25 and over who earn wages (either by working for someone else or through self-employment). As necessitated by Public Law 108-203, there are two versions of the Social Security Statement: one for those who have an earnings history with both covered and non-covered earnings under Social Security, and one for those who have only earnings covered under Social Security. Each version of the Social Security Statement has slightly different language targeted to the type of wages in the earnings history.

SSA plans to use the information we collect from this telephone survey to evaluate customer satisfaction with the Social Security Statement. We will collect information about customer knowledge, awareness, and satisfaction with the various sections and features of the Statement.

Specific research issues explored through the survey include:

• Customer satisfaction or dissatisfaction with the Statement, its various elements and features;

• Factors that may influence customer satisfaction or dissatisfaction with the Statement;

• Outcomes affected by satisfaction/dissatisfaction;

• Customer segments among which satisfaction with the Statement may vary; and,

• Retirement planning activities.

DESCRIPTION OF RESPONDENTS:

Our methodology calls for a nation-wide random sample of 1,200 telephone interviews with Statement recipients evenly divided among various age groups 25 to 59:

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Faye Lipsky, _Reports Clearance Officer, Social Security Administration

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X ] No

2. If yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No N/A

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (minutes)	Burden (hours)
Survey participants	1,200	11 minutes	220
Totals	1,200	11 minutes	220

FEDERAL COST: The estimated annual cost to the Federal Government is $102,000.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

We will draw from a random sample of people who received their Social Security Statements in September 2012 or those who have accessed their Statement online. Our contractor will conduct a 10-12 minute telephone survey of Statement recipients who have an earnings history with both covered and non-covered earnings under Social Security and those who have only earnings covered under Social Security.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[X ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X ] Yes [ ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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