The agency made significant modifications to the Supporting Statement A to provide additional detail regarding the operation of the information collection and the purpose for collecting certain fields on the information collection.
Prior to triannual renewal, the agency will incorporate into a revised version of the Supporting Statement A data on the responsiveness to each question pertaining to resources and income. In addition, the agency will evaluate this form and notice as a priority for usability testing with a goal of further reducing burden on respondents through improved design, choice architecture, and other reforms consistent with the PRA and M-22-10.
Inventory as of this Action
Requested
Previously Approved
07/31/2027
36 Months From Approved
07/31/2024
900,580
0
986,551
497,086
0
464,389
0
0
0
The Medicare Modernization Act of 2003 mandated the creation of the Medicare Part D prescription drug coverage program and provided for certain subsidies for eligible Medicare beneficiaries to help pay for the costs of prescription drugs. SSA uses Form SSA-1020 (and the i1020, its electronic counterpart), the Application for Extra Help with Medicare Prescription Drug Plan Costs, to collect information to make Part D subsidy eligibility determinations. The respondents are Medicare beneficiaries or applicants applying for Part D low income subsidy.
When we last cleared this IC in 2018, the burden was 464,389 hours. However, we are currently reporting a burden of 419,801 hours. This change stems from a decrease in the number of responses from Medicare beneficiaries applying for Extra Help from 986,551 to 900,580. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.
* Note: The total burden reflected in ROCIS is 497,086, while the burden cited in #12 of the Supporting Statement is 419,801. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden for the respondents who respond via field office interviews. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.
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-1020 Application for Help with Medicare Prescription Drug Plan Costs
Addendum - 0696.docx
Application for Help with Medicare Prescription Drug Plan Costs (Paper Form)