SSA-9301 Medicare Subsidy Quality Review Case Analysis Questionnnaire

Justification for Non-Substantive Changes for SSA-9301

Medicare Subsidy Quality Review

Forms SSA-9301, -9302, -9303, -9304, -9308, -9310,

-9311, -9312,- 9313, -9314 -8510

20 CFR 418(b)(5)

OMB No. 0960-0707

Background

Since August 2005, SSA has used the Medicare Subsidy Quality Review (OMB No. 0960-0707) case analysis system, to conduct the required review/verification of select Medicare Part D Subsidy recipients. In this system, SSA contacts a random sample of applicants for the Medicare Part D Subsidy and tells them to expect a telephone call from the agency. During this phone call, SSA employees interview applicants to confirm and perhaps expand on information they reported on Form SSA-1020, Application for Extra Help with Medicare Prescription Drug Plan Costs (OMB No. 0960-0696).

SSA-9301

The SSA-9301, the Medicare Subsidy Quality Review Case Analysis Questionnaire, is the telephone questionnaire SSA employees administer to applicants for the Medicare Part D Subsidy. It includes questions about the applicant’s family size, marital status, income, assets, etc.

Revisions

We are revising and simplifying this form to make it more user friendly for both the reviewer and applicant. We are not asking for any more or less information from the applicant. The SSA-9301 average burden per response will remain at 30 minutes.

We identified areas for improvement based on our usage of this form for the past five years. The revised language on the form will allow the reviewer and the applicant a better understanding of the questions we are asking. The meaning of the questions remains the same. The reformatting on the form makes it more straightforward for the reviewer to administer, thus easier for the applicant to answer.

A description of the four columns in the form follows:

• SSA Records Column – is for the use of the employee conducting the interview;

• Interview Column – is to record information from the applicant during the interview;

• Verification Column – is to document any evidence provided by the applicant and record the results of collateral contacts;

• Conclusion Column – is to summarize the results of the review by the employee.

Some notable changes are:

• Consistency of acronym usage throughout the form e.g., BN for beneficiary, LWS for Living-with Spouse, FS for Family Size, LR for Liquid Resources, NHRP for Non Home Real Property, UI for Unearned Income, EI for Earned Income.

• We added a Remarks section for elements not containing a remarks section so the employee does not need to put all remarks on the last page of the form.

• We removed Conclusion Columns containing Deficiency, No deficiency, and No change checkboxes and replaced with Difference, Stand Alone Deficiency, and Combined Deficiency checkboxes for Family Size, Liquid Resources, Unearned and Earned Income elements. The reviewer can more easily transfer findings to our electronic coding form.

• On the Facesheet page, we removed Type of Application and Protective Filing wording because this information is not coded. We reworded the exclusion question to correspond with our coding form.

• In the Family Size Interview Column, we added checkboxes to identify family members in the interview so the reviewer can easily determine the household composition. In the Verification Column, we removed two tables that duplicated information in the Interview Column.

• We added check boxes for No Unearned or Earned Income to the Unearned and Earned Income Interview columns. Only that box is checked if the applicant has no income.

• The Earned Income Interview Column question is reworded for easier understandability by the reviewer.

• For Unearned Income and Earned Income Verification Columns we removed the Unearned Income exclusion entries since this information is contained on a separate worksheet in our review documentation.

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