Addendum to the Supporting Statement for 0960-0105

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Addendum to the Supporting Statement for Form SSA-1372-BK and SSA-1372-BK-FC,

Advance Notice of Termination of Child’s Benefits and

Student’s Statement Regarding School Attendance

20 CFR 404.350-404.352, 404.367-368

OMB # 0960-0105

Revisions to the Collection Instruments

The Social Security Administration redesigned the Forms SSA-1372-BK and SSA-1372-BK-FC to improve payment accuracy in its Title II student benefit program, and the Forms received approval from the Office of Management and Budget in November 2005. SSA’s Forms Management subsequently determined that the cleared version would not be cost-effective to print. We have again redesigned the form and are making the following substantive changes to the version that OMB approved in November 2005:

SSA-1372-BK:

• We are updating the language designed to determine whether the claimant is a fugitive felon or probation/parole violator.

  • We are changing question #8 on page 2 from “Do you have an unsatisfied warrant issued for your arrest because you were charged with a crime that carries a penalty of death or confinement over 1 year, or do you have an unsatisfied warrant for a Federal or State probation or parole violation?” to “Do you have any unsatisfied felony warrants for your arrest?”

  • and adding question #9: “Do you have any unsatisfied Federal or State warrants for your arrest for violating the conditions of your probation or parole?”

• We updated the penalty statements for both students and school officials.

• We are updating the reporting responsibility in the 6^th bullet on page 6 to read as follows:

You have any unsatisfied felony warrants for your arrest.

• We are updating the reporting responsibility in the 7^th bullet on page 6 to read as follows:

You have any unsatisfied Federal or State warrants for your arrest for violating the conditions of your probation or parole.

• The revised form does not have duplicate pages. We are, therefore, asking school officials to annotate the student’s expected graduation date as certified on the form to the page of the form we ask them to keep for reporting changes in the student’s school attendance.

  • We are also adding a question for school officials to indicate whether they annotated the student’s expected graduation date to the page we ask them to keep. The annotation will assist school officials in determining whether to contact SSA about a change in the student’s scheduled school attendance.

• Because of the increased burden on school officials, we are adding a minute to their estimated average response time.

SSA-1372-BK-FC:

• Language to determine whether the claimant is a fugitive felon or probation/parole violator is being added.

• The revised form does not have duplicate pages. We are, therefore, asking school officials to annotate the student’s expected graduation date as certified on the form to the page we ask them to keep for reporting changes in the student’s school attendance.

  • We are also adding a question for school officials to indicate whether they annotated the student’s expected graduation date to the page we ask them to keep. The annotation will assist school officials in determining whether to contact SSA about a change in the student’s scheduled school attendance.

• Because of the increased burden on school officials, we are adding a minute to their estimated average response time.

Also, the burden on the current versions of the forms was incorrectly stated as it should have read 10 minutes per form. We are correcting this as a part of our revisions so that both forms state the appropriate new burden of 11 minutes.

Implementation

The agency plans to destroy the existing forms SSA-1372-BK and SSA-1372-BK-FC and use the new versions of these forms in order to update the language on the form and improve payment accuracy as soon as we receive approval for the above revisions. The new versions of these forms will be standardized in design by SSA’s Forms Management Team upon approval.