Supporting Statement for Form SSA-371
Request for Reinstatement (Title II)
20 CFR 404.1592b-404.1592f
OMB No. 0960-0742
Justification
Introduction/Authorizing Laws and Regulations
Section
223(i) of the Social Security Act (Act) and Sections 20
CFR 404.1592b - 404.1592f of the Code of Federal
Regulations require the Commissioner of the Social Security
Administration (SSA) to provide regulations for administering Title
II expedited reinstatement (EXR) provisions of the law. SSA allows
certain previously entitled beneficiaries to request EXR of
disability benefits when their medical condition no longer permits
them to perform substantial gainful activity. 20 CFR 404.1592d(a)
states that the individual must make the request for reinstatement in
writing. Section 20 CFR 223(i) of the Act states that
the request for reinstatement form is filed, and includes
declarations by the individual that the individual meets the
requirements specified in the law. SSA uses Form SSA-371, Request
for Reinstatement (Title II), to obtain a signed statement from
individuals requesting reinstatement of their Title II disability
benefits.
Description of Collection
SSA uses Form SSA-371 to obtain: (1) a signed statement from individuals requesting an EXR of their Title II disability benefits; and (2) proof the requestors meet the EXR requirements. SSA maintains the paper form in the disability folder of the applicant to demonstrate the requestors’ awareness of EXR requirements, and their choice to request EXR. If a respondent seeks EXR, they must complete Form SSA-371. Individuals can complete the form independently, or with the help of an SSA employee during an interview. The respondents are applicants for EXR of Title II disability benefits.
Use of Information Technology to Collect the Information
SSA did not create an electronic version of Form SSA-371 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 10,000 respondents complete the form annually. This is less than the GPEA cut-off of 50,000.
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 significantly affect small businesses or other small entities.
Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-371, we would be in violation of sections 20 CFR 404.1592d(a) and 223(i) of the Act, and could not ensure respondents requesting EXR are aware of the requirements and made the choice to request EXR. Because we collect this information on an as needed basis, we cannot collect 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 August 6, 2018, at
83 FR 38441, and we received no public comments. The 30-day FRN published on October 15, 2018 at 83 FR 52042. If we receive any comments in response to this Notice, we will forward them to OMB.
Payment or Gifts to Respondents
SSA does not provide payments 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 Total Annual Burden (hours) |
SSA-371 |
10,000 |
1 |
2 |
333 |
The total burden for this ICR is 333 hours. We based these figures on current management information data. This figure represents burden hours, and we did not calculate a separate cost burden.
Annual Cost to the Respondents (Others)
This collection does not impose a known cost burden to the respondents.
Annual Cost to Federal Government
The annual cost to the Federal Government is approximately $46,200. This estimate accounts for costs from the following areas: (1) designing, printing, and distributing the form; and (2) SSA employee (e.g., field office, 800 number, DDS staff) information collection and processing time.
Program Changes or Adjustments to the Information Collection Request
There are no changes to the public reporting burden.
Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
Displaying 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 | Request for Reinstatement (Title II), SSA-371 |
| Author | Tammy Farmer, OPDR, 59982 |
| File Modified | 0000-00-00 |
| File Created | 2021-01-20 |