This ICR change is approved on the understanding that 1) the minor typos on form 8510, 9302, and 9303 will be fixed prior to fielding the instruments; 2) that no changes are being made to previously approved forms 8510, 9309, and 9310; and 3) that forms 9309, 9310, and 8510 will be used to collect information after the phone interview and that respondents will be aware that their completion of 8510, 9309, and 9310 are voluntary, just as their participation in the phone interview is voluntary.
Inventory as of this Action
Requested
Previously Approved
04/30/2009
04/30/2009
04/30/2009
69,500
0
69,000
17,375
0
17,249
0
0
0
To validate the Medicare Part D subsidy determinations it is making, SSA uses the Medicare Subsidy Quality Review Case Analysis system, in which it calls selected applicants and insurance/other companies to confirm certain information reported on form SSA-1020 (OMB No. 0960-0696). The respondents are applicants for the Medicare Part D subsidy information, insurance companies, and other third parties. This submission is for nonsubstantive wording changes to several of the forms in this collection.
Two new forms were added which increased the overall burden. While these forms a new, the scope of this collection has not changed. Also, there is no actual decrease in burden; it appears this way in ROCIS due to the way ROCIS transferred data from the original paper submission of this form, which predated ROCIS.
NOTE: Please note that although the following forms are attached to this ICR change sheet request, they were not changed in any way from when they were first approved: forms SSA-9308, SSA-9309, SSA-9310, and SSA-8510.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form SSA-8510 SSA-8510
0960-0707 summary of nonsubstantive changes.doc
SSA-9301