Addendum to the Supporting Statement for 0960-0618

Addendum to the Supporting Statement for Social Security Benefits Application:

Form SSA-1: Application for Retirement Insurance Benefits

Form SSA-2: Application for Wife’s or Husband’s Insurance Benefits

Form SSA-16: Application for Disability Insurance Benefits

20 CFR 404.310-404.311, 404.315-404.322, 404.330-404.333, 404.601-404.603, and 404.1501-404.1512

OMB No. 0960-0618

Revision to the Collection Instruments

This addendum summarizes the changes to the three modalities (paper forms SSA-1, SSA-2, and SSA-16; interview/Modernized Claims System (MCS); and Internet/iClaim); changes to the paper form will also be reflected in MCS and on the Internet/iClaim screens.

SSA-1

• Change #1: We are removing question #4(c), “Was a public record of your birth made before you were age 5?” and question #4(d), “Was a religious record of your birth made before you were age 5?” from the Retirement Insurance Benefit Application.

Justification #1: We are removing these questions because the agency no longer needs to develop most proof of age based on the proof of age tolerance policy. Therefore, it is no longer necessary for respondents to complete these questions. If the technician needs to develop for proof of age, he or she will explain to the applicant what we accept as evidence of age.

• Change #2: We are removing question #10(a), “Have you (or has someone on your behalf) ever filed an application for Social Security, Supplemental Security Income, or hospital or medical insurance under Medicare?”; question #10(b), “Enter name of person(s) on whose Social Security record you filed other than application.”; and question #10(c), “Enter Social Security number(s) of person named in (b).”

Justification #2: We are removing questions 10(a)-(c) because we are not required to ask individuals these questions since the information is already in SSA records.

• Change #3: We are removing question #11(a), “Were you in the active military or naval service (including Reserve or National Guard active duty or active duty for training) after September 7, 1939 and before 1968?”; question #11(b), “Enter date(s) of service”; and question #11(c), “Have you ever been (or will you be) eligible for monthly benefits from a military or civilian Federal agency?”

Justification #3: We are removing questions 11(a)-(b) because these questions are no longer relevant. Individuals who apply for benefits today respond “no” to question 11(a) and do not answer (b) and (c) because these questions only apply to claimants under the age of 71.

• Change #4: We are removing information regarding the filing for Medicare only.

Justification #4: The prescribed form for applying for Medicare only is the Application for Hospital Insurance (Part A), Form CMS-18 (OMB Control No. 0938-0251), which is owned by the Center for Medicare and Medicaid Services (CMS). We are currently updating our claim systems to an Intranet-based, Consolidated Customer Experience (CCE) system as part of the IT Modernization effort. These CCE screens will replace using an abbreviated retirement claim path to take a Medicare only application. In addtion, as expected, CMS has always reported the public burden for using the paper CMS-18 under OMB No. 0938-0251. With the renewal package they are currently preparing, they will also include the public burden for using the interview/MCS and iClaim, and we expect they will also submit the pertinent screens for both the new Intranet-based claims system as well as the Internet application screens. Therefore, we are removing this public burden from our burden chart to avoid double counting the burden to the pubilc.

SSA-2

• Change #1: We are removing question #5(c), “Was a public record of your birth made before you were age 5?” and question #5(d), “Was a religious record of your birth made before you were age 5?” from the Wife’s or Husband’s Insurance Benefits Application.

Justification #1: We are removing these questions because the agency no longer needs to develop most proof of age based on the proof of age tolerance policy. Therefore, it is no longer necessary for respondents to complete these questions. If the technician needs to develop for proof of age, he or she will explain to the applicant what we accept as evidence of age.

• Change #2: We are removing question #10(a), “Have you (or has someone on your behalf) ever filed an application for Social Security, Supplemental Security Income, or hospital or medical insurance under Medicare?”; question #10(b), “Enter name of person(s) on whose Social Security record you filed other than application.”; and question #10(c), “Enter Social Security number(s) of person named in (b).”

Justification #2: We are removing questions 10(a)-(c) because we are not required to ask individuals these questions since the information is already in SSA records.

• Change #3: We are removing question #11(a), “Were you in the active military or naval service (including Reserve or National Guard active duty or active duty for training) after September 7, 1939 and before 1968?”; question #11(b), “Enter date(s) of service”; and question #11(c), “Have you ever been (or will you be) eligible for monthly benefits from a military or civilian Federal agency?”

Justification #3: We are removing questions 11(a)-(b) because these questions are no longer relevant. Individuals who apply for benefits today respond “no” to question 11(a) and do not answer (b) and (c) because these questions only apply to claimants under the age of 71.

SSA-16

• Change #1: We are removing question #5(c), “Was a public record of your birth made before you were age 5?” and question #5(d), “Was a religious record of your birth made before you were age 5?” from the Disability Insurance Benefits Application.

Justification #1: We are removing these questions because the agency no longer needs to develop most proof of age based on the proof of age tolerance policy. Therefore, it is no longer necessary for respondents to complete these questions. If the technician needs to develop for proof of age, he or she will explain to the applicant what we accept as evidence of age.

• Change #2: We are removing question #10(a), “Have you (or has someone on your behalf) ever filed an application for Social Security, Supplemental Security Income, or hospital or medical insurance under Medicare?”; question #10(b), “Enter name of person(s) on whose Social Security record you filed other than application.”; and question #10(c), “Enter Social Security number(s) of person named in (b).”

Justification #2: We are removing questions 10(a)-(c) because we are not required to ask individuals these questions since the information is already in SSA records.

• Change #3: We are removing question #11(a), “Were you in the active military or naval service (including Reserve or National Guard active duty or active duty for training) after September 7, 1939 and before 1968?”; question #11(b), “Enter date(s) of service”; and question #11(c), “Have you ever been (or will you be) eligible for monthly benefits from a military or civilian Federal agency?”

Justification #3: We are removing questions 11(a)-(b) because these questions are no longer relevant. Individuals who apply for benefits today respond “no” to question 11(a) and do not answer (b) and (c) because these questions only apply to claimants under the age of 71.

• Change #4: We are updating the reporting responsibilities on the application for disability beneficiaries who receive workers compensation from, “You are under age 65 . . . ” to “You are under full retirement age . . .”

Justification #4: We are updating the language because of the enactment of the Achieving a Better Life Experience (ABLE) Act on 12/19/2014. A provision in the ABLE Act affects Workers’ Compensation/Public Disability Benefit offset by changing the age at which WC/PDB offset ends for disability beneficiaries, from age 65 to full retirement age (FRA), effective 12/19/2015.

Preliminary Claims System (PCS)

• Change #1: We are removing the PCS screens as a collection tool for application questions that we added with the March 2019 Change Request.

Justification #1: Due to reassessing IT Modernization initiatives, we stopped development for the PCS. The focus shifted to creating the Consolidated Claims Experience (CCE), which will replace our current legacy claim system with web-based claims. Once we have the screens ready for the CCE, we will submit them to OMB for approval.

iAppointment/enhanced Leads and Appointment System (eLAS)

• Change #1: We are removing iAppointment and eLAS from the OMB Package.

Justification #1: Due to reassessing IT Modernization initiatives and multiple collection tools within the benefits application package, we are removing iAppointment and eLAS from this package. We use iAppointment and eLAS with more than just iClaim and claims requests, so we are requesting approval for the application under a separate OMB number. To that end, we are submitting a separate package for iAppointment and eLAS which only collects in-person appointment applications. Since we are removing iAppointment and eLAS from under this inforamtion collection request, we are also removing the burden hours for iAppointment and eLAS from this package.

iClaim for SSA-1, SSA-2, and SSA-16

• Change #1: We are updating the benefit application package to show iClaim as a modality to collect benefit application information. We will also be updating the burden chart to reflect iClaim as a type of modality instead of a separate application.

Justification #1: iClaim is not a benefit application, but a way we collect information from the public online for the benefit applications SSA-1, SSA-2, and SSA-16.

• Change #2: We are removing information regarding the filing for Medicare only from this information collection request.

Justification #2: The prescribed form for applying for Medicare only is the Application for Hospital Insurance (Part A), Form CMS-18 (OMB Control No. 0938-0251), which is owned by the Center for Medicare and Medicaid Services (CMS). We are currently updating our claim systems to an Intranet-based, Consolidated Customer Experience (CCE) system as part of the IT Modernization effort. These CCE screens will replace using an abbreviated retirement claim path to take a Medicare only application. In addtion, as expected, CMS has always reported the public burden for using the paper CMS-18 under OMB No. 0938-0251. With the renewal package they are currently preparing, they will also include the public burden for using the interview/MCS and iClaim, and we expect they will also submit the pertinent screens for both the new Intranet-based claims system as well as the Internet application screens. Therefore, we are removing this public burden from our burden chart to avoid double counting the burden to the pubilc.

CMS-40B (Medicare Part B)

• Change #1: We are removing the online screens for the CMS-40B (OMB Control No. 0938‑1230).

Justification #1: On July 27, 2020, CMS requested approval to transfer the online screens for the CMS-40B under OMB No. 0938-1230 because CMS owns the application and the public accesses the screens on CMS’s website. We requested this transfer from OMB after we received approval for the CMS-40B screens.

We will make the above changes upon OMB’s approval of this information collection request.

Future Plans: As we mentioned above, we are currently in the process of updating our Modernized Claims System (MCS) with the new Consolidated Customer Experience (CCE) screens. We do not have the updated screens ready, yet, for this information collection; however, once we do, we will submit them via Change Request to remove the MCS screens and replace them with the CCE screens. We hope to have these screens ready within the next three years.