Addendum to the Supporting Statement for 0960-0133

Addendum to the Supporting Statement for Form SSA-8508 BK

Supplemental Security Income (SSI)-

Quality Review Case Analysis

OMB No. 0960-0133

Minor Revisions to the Collection Instrument, e8508

• Change #1: We are revising Element 6, Living Arrangement (LA) on the e8508 (Household Composition screen) to rename the “All PA Household” field to “PA Household”:

Justification #1: We are making this revision to reflect a recent change in policy due to the publication of the final rule to Expand the Definition of a Public Assistance Household.

• Change #2: We are revising Element 6, Living Arrangement (LA) on the e8508 (Household Composition screen) to remove the field for FOOD.

Justification #2: We are making this change to reflect a recent change in policy due to the publication of the final rule, Omitting Food From In-Kind Support and Maintenance Calculations.

• Change #3: We are revising Element 6, Living Arrangement (LA) on the e8508 (Other Household LA Situations screen) to remove and add questions about food:

We removed the following questions:

• SI eats all meals out?

• If NO, buy food separate from household?

• SI's contribution earmarked for shelter?

• SI's contribution earmarked for food?

We added the following questions:

• SI Receives SNAP/Food Stamps?

• Do others within the household pay for or provide the SI/Deemor with all their meals?

Justification #3: We are making this change to reflect a recent change in policy due to the publication of the final rule, Omitting Food From In-Kind Support and Maintenance Calculations.

• Change #4: We are revising Element 6, Living Arrangement (LA) on the e8508 (Ineligible Children screen) to add the following question: Was the IC/Sibling a Student During the Review Period?

Justification #4: This question helps clarify if we need to develop student exclusions on the income screens.

• Change #5: We are revising Element 6, Living Arrangement (LA) on the e8508 (LA/ISM Determination screen) to remove and add the following fields:

We removed the following fields:

• Food Expense

• FOOD

• FOOD/SHELTER

We added the following field:

• Unstated Income Suspected

Justification #5: We are making this change to reflect a recent change in policy due to the publication of the final rule, Omitting Food From In-Kind Support and Maintenance Calculations.

• Change #6: We are revising Element 9, Unearned Income (Main Screen) on the e8508 to remove and add the following items:

We removed the following fields (Only for the IC-1 through IC-5)::

• Title XVI questions

We added the following question (only for the SI):

• Unstated Income

Justification #6: These revisions reflect recent changes in policy.

• Change #7: We are adding a new screen to the e8508, the Unstated Income Detail Screen. This screen will apply only to the SI. We created it to allow the OQR reviewer to determine if there is potential Unstated Income. The reviewer will determine this by comparing expenses and income amounts already captured on prior screens.

Justification #7: This new screen will assist reviewers in determining if Unstated Income exists.

• Change #8: We are revising Element 13, Living Arrangement (LA) (Negative Property Screen) on the e8508 to remove and add fields; reorganize the fields; and add check boxes:

• We removed the following fields for SI:

• Name(s) Search

• Jurisdiction Searched

• County/Parish/City

• ST

• Alpha Listing

• Contact Method

• Name of Contact

• Date of Contact

• Contact Information

• We added the following field:

• SSN(s) search

• We reorganized the MI pages into two:

  • SSN Search

  • Name Search

• We added three check boxes next to the determination field (SI, MI-1 and MI-2):

Justification #8: We removed the name search as it is not necessary for the SI, we only need SSN via third party system to identify potential ownership of unknown properties. For the Mis, the user can choose to do either an SSN search or Name search. Finally, we added the checkboxes to allow the QRA to indicate for which member of the Household the properties belong to.

We will make these revisions upon OMB approval. These revisions do not significantly change the current burden per response for the screens; therefore, we did not adjust the burden in #12 of the Supporting Statement due to these revisions.