Background
In 2013, OMB agreed to change the language and layout of the 2014 MYM forms as a result of WBDOC’s request. However, the changes to the forms resulted in unfavorable feedback for the workload. WBDOC would like to request to implement the minor changes listed below for the upcoming 2015 workload. We would like to change the format for some of the questions back to the original 2013 version of the forms. In addition, we would like to add some new language from the 2013 version to the 2015 forms to simplify the form and help make the form more understandable for the reader. We did not add or delete questions from any of the MYM forms.
Timeframe for mailing the MYM forms
We plan to implement these changes upon OMB approval for the next mailing of these forms.
Description of Non-Substantive Form changes
SSA-L9778
Change 1: We are revising questions 1 and 3. The prior version contained boxes for a breakout of Wages and Net Self-Employment. We revised questions 1 and 3 to remove the boxes for Wages and Net Self-Employment so that the only boxes will be for total earnings.
Justification 1: We revised these questions to simplify the form for the reader based on feedback from WBDOC staff that identified these questions as problem areas based on submissions they receive for processing. The instructions section of the form already explains to the reader what to include and what not to include when calculating their total earnings.
SSA-L9779
Change 2: We are revising Question 2 – prior version - “Place an “X” in the box under each month….” Current version - “If you worked for wages, place an “X” in the box under each month….”
Justification 2: We revised these questions to simplify the form for the reader based on feedback from WBDOC staff that identified these questions as problem areas based on submissions they receive for processing.
Change 3: We are revising Question 5 – the prior version contained boxes for a breakout of Wages and Net Self-Employment. We revised question 5 to remove the boxes for Wages and Net Self-Employment so that the only boxes will be for total earnings.
Justification 3: We revised this question to simplify the form for the reader based on feedback from WBDOC staff that identified these questions as problem areas based on submissions they receive for processing. The instructions section of the form already explains to the reader what to include and what not to include when calculating their total earnings.
SSA-L9781
Change 4: We are revising Question 2 – prior version - “Place an “X” in the box under each month….” Current version - “If you worked for wages, place an “X” in the box under each month….”
Justification 4: We revised these questions to simplify the form for the reader based on feedback from WBDOC staff that identified these questions as problem areas based on submissions they receive for processing.
Change 5: We are revising Question 5 – the prior version contained boxes for a breakout of Wages and Net Self-Employment. We revised question 5 to remove the boxes for Wages and Net Self-Employment so that the only boxes will be for total earnings.
Justification 5: We revised this question to simplify the form for the reader based on feedback from WBDOC staff that identified these questions as problem areas based on submissions they receive for processing. The instructions section of the form already explains to the reader what
SSA-L9785
Change 6: We are revising Question 3 – prior version - “Place an “X” in the box under each month….” Current version - “If you worked for wages, place an “X” in the box under each month….”
Justification 6: We revised these questions to simplify the form for the reader based on feedback from WBDOC staff that identified these questions as problem areas based on submissions they receive for processing.
SSA-L9790
Change 7: We are revising– Page 1 of the Questionnaire in section titled, “Your Monthly Earnings”, second sentence of first paragraph – prior version “However, if we know how much you plan to earn in each month in 2015 we may be able to pay you more.” Current version - “However, if we know how much you earned before taxes in each month in [year] we may be able to pay you more.” Question 1 – prior version - “Place an “X” in the box under each month….” Current version - “If you worked for wages, place an “X” in the box under each month….”
Justification 7: We revised the language on page 1 of the Questionnaire by adding the words “before taxes” to the second sentence of the first paragraph to make it more specific to the reader as to the information we are requesting. Question 1 – We revised these questions to simplify the form for the reader based on feedback from WBDOC staff that identified these questions as problem areas based on submissions they receive for processing.
SSA-L9778, SSA-L9779, and SSA-L9781
Change 8: We reformatted the “Our Last Question” instructions to bold the first sentence. The prior version has the same wording, we just bolded the first sentence, “If you will reach full retirement age in January [year], you do not have to complete this question.”
Justification 8: To make the instructions more understandable for the reader, we have the first sentence of the instructions in bold type. We believe this will help to clarify the question for the reader and help readers that have reached full retirement age to understand that they do not have to answer this question.
Change 9: We revised item 2 of the Privacy Act Statement on each form contained in this clearance package to remove the apostrophe after Veterans in Veterans’ Affairs.
Justification 9: We revised the Privacy Act Statement on each form to remove the apostrophe after Veterans’ in Veterans Affairs, as there should be no apostrophe in the title. It should read …and the Department of Veterans Affairs.
| File Type | application/msword |
| File Title | Supporting Statement for Form SSA-1372-BK and SSA-1372-BK-FC, |
| Author | Linda Mitchell, OISP, 51327 |
| Last Modified By | 889123 |
| File Modified | 2015-06-02 |
| File Created | 2015-06-02 |