POD Informed Consent Form

APPENDIX A

Date
NAME
ADDRESS
CITY, STATE ZIP
Dear ,
We are sending this letter to let you know about a new Social Security Administration (SSA)
project. SSA is testing new rules for the Social Security Disability Insurance (SSDI) program.
The new rules will give people the chance to earn more money from work and to keep more of
their benefits than they can now. This project is called the Promoting Opportunity Demonstration
or POD. POD will determine whether these new rules help people who want to go back to work
or work more. SSA has hired Abt Associates and Mathematica Policy Research to work on
SSA’s behalf and they may contact you. Abt Associates is helping run the POD program, and
Mathematica Policy Research is studying it. You are invited to sign up today!
Under the new rules your cash benefits go down little by little as you earn more instead of
stopping completely if you earn too much. This change could help you make more money if you
expect to earn more than $1,170 a month from working. You can use a benefits calculator to help
you figure out how much your benefit payment will change under the new POD rules
(www.podssa.org).
It is your choice to sign up. To sign up, please fill out the survey and complete and sign the last
two pages of the attached consent form in this packet. Please return the forms using the envelope
provided. You will be paid $25 for returning the completed survey and signed consent form.
To learn more about this study, please read the enclosed brochure. You can also go to
www.podssa.org. Everyone that signs up will have a two in three chance to be randomly
assigned to the new POD rules and a one in three chance to be randomly assigned to SSA’s
current rules. You can also call the study’s helpline at 888-771-9188. POD project staff will give
you information to help you decide whether to sign up. If you would like help in completing the
survey, please call the study’s helpline at 888-771-9188.
Enroll today and see how POD can work for you! We look forward to speaking with you!
Sincerely,
Kate Bent, RN, PhD
Associate Commissioner
Social Security Administration

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APPENDIX A

Privacy Act Statement
Collection and Use of Personal Information
Section 234 of the Social Security Act, as amended, allows us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the
information may prevent you from participating in the Promoting Opportunities Demonstration
(POD) project.
We will use the information you provide to manage your participation in the POD project and for
research and statistical purposes. We may also share your information for the following
purposes, called routine uses:
1.

To contractors and other Federal agencies, as necessary, for the purpose of assisting the
Social Security Administration (SSA) in the efficient administration of its programs; and

2.

To a congressional office in response to an inquiry from that office made at the request of
the subject of a record.

In addition, we may share this information in accordance with the Privacy Act and other Federal
laws. For example, where authorized, we may use and disclose this information in computer
matching programs, in which our records are compared with other records for various purposes
related to the agency’s administration of Federal benefit programs, including recovering Federal
benefit programs overpayments.
A list of additional routine uses is available in our Privacy Act System of Records Notice
(SORN) 60-0218, entitled Disability Insurance and Supplemental Security Income
Demonstration Projects and Experiments System; 60-0090, entitled Master Beneficiary Record;
60-103, entitled Supplemental Security Income Record and Special Veterans Benefits; 60-0094,
entitled Recovery of Overpayments, Accounting, and Reporting, and 60-330, entitled eWork.
Additional information and routine uses, and a full listing of all our SORNs, are available on our
website at www.socialsecurity.gov/foia/bluebook.

Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer the survey questions unless we display a valid Office of Management and Budget
(OMB) control number. The OMB control number for this collection is 0960-XXXX; expiration date XX/XX/20XX. We
estimate that it will take about 20 minutes to read the instructions, and answer the survey questions. You may send comments
about our time estimate to: Social Security Administration, 6401 Security Blvd, Baltimore, MD 21235-6401

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