Addendum 0960-0483

Addendum to the Supporting Statement for SSA-3033

Work Activity Questionnaire

20 CFR 404.1574(a)(1) – (3)

OMB No. 0960-0483

Revision to the Collection Instrument

• Change 1: We are revising the language on page 1:

  • Old Language: Dear Sir/Madam

  • New Language: Greetings

Justification 1: We are revising the language to comply with gender neutral language.

• Change 2: We are revising the language on page 1:

  • Old Language: This individual has indicated to us (s)he worked for your organization, but that the work was either limited in nature, subsidized, or ultimately unsuccessful.

  • New Language: The worker listed above has indicated to us that their work activity may be performed with employer-provided accommodations or under special conditions which may indicate that the work is subsidized.”

Justification 2: We are revising the language, per members of an internal workgroup made up of Social Security Employees who are familiar with processing these cases, some employers are reluctant to complete and return the form because they fear they are speaking negatively about their employee. Additionally, employers were not completing the form if the employee was not currently employed.

• Change 3: We are revising the language on page 1 under the Information About Subsidy section:

  • Old Language: A subsidy exists when an employer willingly pays more in wages than the value of the actual services performed.,

• New Language: When an employee’s work is subsidized, we do not consider any earnings above the reasonable value of the work or services performed.

Justification 3: We are revising the language per members of the workgroup and the recommendations in OIG Audit 22021019, currently when the user receives this form there is often a misunderstanding of how SSA will use the information. The new sentence provides a better definition of the term while simultaneously informing the user why we need the information and how it will be used to reduce countable earnings.

• Change 4: We are revising the language on page 1 under the Information About Subsidy section to update existing examples:

  • Old Language: This is usually for humanitarian reasons. A subsidy can be reflected by giving the employee:

    • extra assistance,

    • full wages for lower quality or quantity than standard, or

    • fewer and/or easier duties than usual for that position

• New Language: A subsidy may exist when the employee works under any of the following conditions:

  • Receives extra assistance;

  • Work activity is limited in nature;

  • Has fewer or easier duties than usual for the position;

  • Takes additional breaks or time off as an accommodation; or

  • has other special conditions or emplo0yer accommodations.

Justification 4: We are revising the language, because a SSA Audit indicated that

Form SSA-3033 contains insufficient instructions and that users have expressed confusion about how to complete the form correctly. Adding additional examples of when a subsidy may exist and explaining why the information is needed addresses this concern.

• Change 5: We are removing the Information about Unsuccessful Work Attempt section on page 1.

Justification 5: We are removing this section, because we removed the requirement for employer verification of an Unsuccessful Work Attempt

• Change 6: Page 2 “What We Need You to Do”:

  • Old Language: Please have _________ direct supervisor or another person having direct knowledge of the employee’s work activity complete the work activity questionnaire. We would appreciate it if you would complete, sign and return the questionnaire to this office within 7 days using the enclosed envelope. If you have any questions, or if you would rather provide this information over the phone, please call _______and ask for ___________.

Thank you for your time and assistance.

Manager/Adjudicator Name

Position Title

• New Language: Please have someone, other than the employee, with direct knowledge of the employee, with direct knowledge of the employee’s work activity complete the work activity questionnaire. This could be a supervisor or the employee’s employment service provider, such as a job coach, job developer, or other knowledgeable source. The information you provide will help us determine the true value of the services performed. We would appreciate it if you would complete and return the questionnaire to this office within 15 days, or as soon as possible. If you have any questions, or if you would rather provide this information over the phone, please call ___________ and ask for _______.

Thank you for your time and assistance.

Justification 6: We updated the paragraph to soften the language, to make it less employer centric, to better define subsidy, convey what information is needed, and why. We also lengthened the return time from 7 days to 15 days. We also added “or as soon as possible” to the return time. We are revising the language as per a SSA Audit and the workgroup, individuals completing the form often did not understand why we needed the information. We removed the name and number of the SSA technician in case the person filling out the form has questions, because having Social Security Administration as the closing is consistent with the cover letters of the other Work CDR forms.

• Change 7: We are adding language under the Work Activity Questionnaire section on page 4:

  • New Language: Employee Name _________Employee’s SSN: ______

• Justification 7: We are adding this language because the current version of the form does not have the name on the first page of the questionnaire and the SSN is somewhat hidden at the top of the form. Oftentimes when returned, only the questionnaire is returned without the accompanying cover letter. It is then difficult for the SSA technician to associate the form with the appropriate file.

• Change 8: We are revising the language under the Work Activity Questionnaire section on page 4:

  • Old Language: Business Name

  • New Language: Business/Employer Name

Justification 8: We are revising the language for clarity as workgroup who often had confusion on how the user would complete this if they were an individual employer as opposed to a business.

• Change 9 We are revising the language, and moving the location before the Wage/Salary and Hours per Week section under the Work Activity Questionnaire section on page 4:

  • Old Language: Date Work Stopped

  • New Language: Date Work Ended (if applicable)

Justification 9: We are moving the information to provide a better flow of the form. We are revising the language for clarity as per feedback from workgroups who indicated that sometimes the employer would not complete the form because of confusion as to whether it applied to current employees only, former employees only, or both.

• Change 10: We are revising the language under the Work Activity Questionnaire section on page 4:

  • Old Language: Hourly Wage

  • New Language: Hourly Wage/Salary

Justification 10: We are revising the language for clarity as per feedback from workgroup who state oftentimes the individual completing the form would leave this blank if the employee was a salaried employee and not paid an hourly wage. This change will indicate that this information is necessary regardless of which the employee receives.

• Change 11: We are removing language on language on pages 4, Section 1, question 5, and revising the question:

  • Old language: Please indicate the type(s) of special assistance, if any, the employee receives on the job that is not regularly given to other employees. (Check all that apply).

  • New Language: Does the employer provide any accommodations not covered above? Yes__ No__

• If yes, please describe in Section 2, Remarks

Justification 11: We are revising the language to soften the language; provide examples; encourage consistency; reduce the risk of the user providing conflicting information; and overall to provide more inherent instruction and make the form more understandable and user friendly.

• Change 12: We are adding a lead paragraph under the Work Activity Questionnaire section on page 4, Section 1:

• New Language: The following questions will help us to determine if the employer provides accommodations that support the employee’s work effort. Please answer the questions based on your direct knowledge of the employee’s work activities.

Justification 12: We are adding the language to provide clarity.

• Change 13: We are adding conditional pathway language under the Work Activity Questionnaire section on page 4, Section 1 after question 5:

• New Language: If the answer to any of the above is “Yes,” please proceed to Question 6

If the answer to all of the above is “No,” please proceed to Section 3

Justification 13: We are adding the language as per feedback from the workgroup and the SSA audit, oftentimes the technician would receive contradictory information on the

SSA-3033. This was in large part when the user would not indicate accommodations or special assistance yet would indicate a percentage of other’s productivity. Or, conversely, they would indicate accommodations or special assistance and would not indicate a percentage of others productivity. With this change, if the user does not indicate any accommodations, the form directs the user to the contact information block, bypassing the percentage question altogether.

• Change 14: We are revising the language Work Activity Questionnaire section on page 4, Section 1, question 6:

  • Old Language: Based on the information above, approximately how would you rate the productivity of the employee compared to other employees in similar positions and similar rates?

  • New Language: Based on the answers above what is the reasonable value of the work or services performed? Please see the following examples of how to determine a subsidy percentage:”

Justification 14: We are revising the language to provide definitions of subsidy consistent with other places on the form and provides a lead in sentence to the examples which are designed to assist the user in calculating percentage values of subsidy.

• Change 15: We are adding two examples of subsidy calculation under the Work Activity Questionnaire section on page 4, Section 1, question 6.

Justification 15: We are adding the examples to assist the user in calculating percentage values of subsidy. The examples give the user an example with an hourly wage, one with a salary, and each with subsidized work. The user can use the examples as a guide with their unique information, to determine a percentage value of the subsidy. This will also lead to better information for the SSA technician to ultimately use in the development of subsidy.

• Change 16: We are adding lead in to the actual percentage s under the Work Activity Questionnaire section on page 4, Section 1, question 6.

  • New Language: Approximately what percentage of this employee’s pay exceeds the reasonable value of the work or services they perform? Please provide any justification in Section 2, Remarks.

Justification 16: We are adding the language for clarity and to reiterate SSA’s definition of subsidy.

• Change 17: We are revising the scope of the percentage section under the Work Activity Questionnaire section on page 4, Section 1, question 6 to include values of subsidy from 10% - 100% and included an “Other” option should the employer calculate a subsidy other than those listed.

Justification 17: We are revising the scope to make the form easier to understand and complete for the user and to provide for more consistent application of the subsidy on the part of the SSA technician.

• Change 18: We are removing Section 2, Unsuccessful Work Attempt on Page 5.

Justification 18: We are removing this section, as it exists on the current form, and SSA removed the requirements for employer verification of Unsuccessful Work Attempt.

• Change 19: We are adding a remarks section on Page 5, Section 2.

Justification 19: We are adding a remarks section to provide a space for the user to give SSA any additional information and to provide clarity on any of the answers they provided previously on the questionnaire. This will help the technician with development, understanding the intent of the user as well as provide a vehicle for the user in situations that may not fit the mold exactly as outlined on the form. This provides flexibility while at the same time reducing the receipt of incomplete or contradictory information. It has the potential to provide more case specific information to the technician, thus easing the burden of complex development.

• Change 20: We are revising the in the Signature Block, language on page 5, Section 3, requesting a Printed name as opposed to a signature.

Justification 20: SSA no longer requires a wet signature on Form SSA-3033. Based on workgroup user’s experiences, the signature was often illegible which made recontact with the user difficult, and at times impossible. This change has the potential to ease some development burdens of SSA technicians.

• Change 21: We are adding a Contact Information requesting the name of the organization or the Employer Name for whom the person completing the form is associated, on page 5 Section.

Justification 21: We are adding the information as per feedback from the workgroup and due to the fact that SSA has made the form less employer centric, meaning a knowledgeable source other than the employer can complete the form and the person completing the form can identify their employer or organization.

SSA will make the above revisions to the form upon OMB’s approval. We do not anticipate any change to the burden due to these revisions.