Supporting Statement For Forms
SSA-9301, SSA-9302, SSA-9303, SSA-9304, SSA-9308, SSA-9310,
SSA-9311, SSA-9312, SSA- 9313, SSA-9314
Medicare Subsidy Quality Review Forms
20 CFR 418(b)(5)
OMB No. 0960-0707
A. Justification
Introduction/Authoring Laws and Regulations
Under the aegis of the Medicare Modernization Act of 2003, the Social Security Administration (SSA) makes Medicare Part D subsidy redeterminations of continued eligibility. We base the subsidy redeterminations on beneficiaries’ answers to questions about categories such as household size, income, and assets. Since applicants self-report this information using Form SSA-1020 (OMB No. 0960-0696), the application form for the Part D subsidy, SSA needs a way to determine if the information is accurate and complete, as per section 1860 D-14(a)(3)(E)(iii)(III) of the Social Security Act and section 20 CFR 418(b)(5) of the Code of Federal Regulations.
Since August 2005, SSA uses 0960-0707, the Medicare Subsidy Quality Review Case Analysis system, to conduct the required review and verification of select 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 phone call from the agency. During this phone call, SSA interviews applicants to confirm, and perhaps expand on, information they reported on Form SSA-1020 (OMB No. 0960-0696). As part of the Quality Review program, we may ask applicants to give written consent for SSA to contact financial institutions and other third parties to confirm information from applicants’ SSA-1020.
Description of Collection
SSA uses the 11 information collection tools in this information collection request to conduct the Medicare Subsidy Quality Review. The purpose of these tools is to help SSA confirm the information reported on Form SSA-1020 and to validate its Medicare Part D subsidy determinations. We are removing the burden hours for the SSA-8510 in this IC, we still use the SSA-8510, but we account for it under OMB No. 0960‑0801. We list and describe the information collection tools below:
SSA-9301: Medicare Subsidy Quality Review Case Analysis Questionnaire - This 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.
SSA-9302: Notice of Appointment-Reviewer Will Call - After receiving notice of the scheduled date and time of the telephone questionnaire, Part D applicants return this form confirming their availability for the interview, and making note of any special needs for the call. This version is for applicants whose phone numbers we already know and, thus, for whom we can pre‑schedule the call.
SSA-9303: Notice of Appointment-Please Call Reviewer - This form is similar to Form SSA-9302, except it is for participants who do not have phones, or for those participants for whom SSA does not know the phone numbers. On this form, participants confirm receipt of the letter and we ask them to call SSA on a specified date.
SSA-9304: Checklist of Required Information - This checklist, which accompanies Forms SSA-9302, SSA-9303, SSA-9311, SSA-9312, SSA-9313, and SSA-9314, is a list of the documentation respondents need to have available when SSA calls them to conduct the Quality Review phone interview. We account for the burden for this checklist in the burdens for Forms SSA-9302, SSA-9303, SSA-9311, SSA-9312, SSA-9313, and
SSA-9314, therefore; we do not account for the burden separately.
SSA-9308: Request for Information - SSA sends this form to various third parties (e.g., businesses besides insurance companies) to obtain or confirm information applicants report for the Part D subsidy.
SSA-9310: Request for Documents - Following the phone interview, SSA sends this notice to the applicants advising them of the documents they must return to SSA.
SSA-9311: Notice of Appointment–Denial–Reviewer Will Call - After receiving notice of the scheduled date and time of the telephone questionnaire, Part D applicants return this form confirming their availability for the interview, and making note of any special needs for the call. This version is for applicants whose phone numbers we know and, thus, we can pre-schedule the call. We tailored the language on this form for those Part D subsidy applicants with denied applications.
SSA-9312: Notice of Appointment-Denial-Please Call Reviewer - This form is similar to Form SSA-9311, except it is for participants who do not have phones, or for whom SSA does not know the phone numbers. On this form, participants confirm receipt of the letter, and we ask them to call SSA on a specified date. This form is also designed for Part D subsidy applicants whose applications we denied.
SSA-9313: Notice of Appointment-Redetermination-Reviewer Will Call - After receiving notice of the scheduled date and time of the telephone interview, Part D beneficiaries return this form confirming their availability for the interview, and making note of any special needs for the call. This version is for beneficiaries whose phone numbers we know and, thus, we can
pre-schedule the call.
SSA-9314: Notice of Appointment-Redetermination-Reviewer Will Call - This form is similar to Form SSA-9313, except it is for beneficiaries who do not have phones, or for whom SSA does not know the phone numbers. On this form, beneficiaries confirm receipt of the letter and we ask them to call SSA on a specified date.
SSA-8510: Authorization to the Social Security Administration to Obtain Personal Information - Applicants for the Part D subsidy complete this form authorizing SSA to contact third parties to confirm information reported on Form SSA-1020 (OMB No. 0960-0696). The burden for SSA-8510 is provided under OMB number 0960-0801, therefore; we do not account for the burden here.
Use of Information Technology to Collect the Information
SSA did not create an electronic version of Forms SSA-9301, SSA-9303, SSA-9304, SSA-9308, SSA-9310, SSA-9311, SSA-9312, SSA-313, SSA-9314, and SSA-8510 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 21,350 respondents complete the form. This is less than the GPEA cut-off of 50,000. In addition, we use this collection to send out notifications.
Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it precludes duplication. SSA does not use another collection instrument to obtain similar data.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
Consequence of Not Collecting Information or Collecting it Less Frequently
If SSA did not collect this information, SSA would be unable to conduct the mandatory verification of information reported in OMB No. 0960-0696. Because we only conduct the Medicare Subsidy Quality Review process once per selected participant, we cannot conduct it less frequently. There are no technical or legal obstacles to burden reduction.
Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on July 13, 2017, at
82 FR 32431, and we received no public comments. The 30-day FRN published on September 19, 2017, at 82 FR 43804. If we receive any comments in response to this Notice, we will forward them to OMB. We did not consult with the public in the revision of these forms.
Payment or Gifts to the Respondents
SSA does not provide payment or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects 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.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Annual Burden (hours) |
SSA-9301 (Medicare Subsidy Quality Review Case Analysis Questionnaire) |
3,500 |
1 |
30 |
1,750 |
SSA-9302 (Notice of Quality Review Acknowledgement Form for those with Phones) |
3,500 |
1 |
15 |
875 |
SSA-9303 (Notice of Quality Review Acknowledgement Form for those without Phones) |
350 |
1 |
15 |
88 |
SSA-9308 (Request for Information) |
7,000 |
1 |
15 |
1,750 |
SSA-9310 (Request for Documents) |
3,500 |
1 |
5 |
292 |
SSA-9311 (Notice of Appointment- Denial -Reviewer Will Call) |
450 |
1 |
15 |
113 |
SSA-9312 (Notice of Appointment-Denial-Please Call Reviewer) |
50 |
1 |
15 |
13 |
SSA-9313 (Notice of Quality Review Acknowledgement Form for those with Phones) |
2,500 |
1 |
15 |
625 |
SSA-9314 (Notice of Quality Review Acknowledgement Form for those without Phones) |
500 |
1 |
15 |
125 |
Total |
21,350 |
|
|
5,631 |
Based on our current management information data, the total of 5,631 hours represents burden hours, and we did not calculate a separate cost burden.
Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government for this collection is approximately $245,934. This estimate is a projection of the costs for printing and distributing the collection instruments and for SSA staff conducting the quality review interviews.
Change in Reporting Burden.
The decrease in burden stems from removal of the burden hours for the SSA-8510 in this ICR. We still use the SSA-8510, but the burden hours are accounted for under OMB Control No. 0960-0801. Since we removed these burden hours, it also caused a decrease in completion time, resulting in a change in burden.
Plans for Publication Information Collection Results.
SSA will not publish the results of the information collection.
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.
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).
Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | SUPPORTING STATEMENT FOR FORMS SSA-9301, SSA-9302, SSA-9303, SSA-9304, SSA-9308, SSA-9309, SSA-9310, and SSA-8510 |
| Author | SME |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |