Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook

Forms and Documents

Document Name	Status
Form SSA-2930 SSA-2930 Form	Modified
Form SSA-2935 SSA-2935 Form and Instruction	New
Form SSA-85 SSA-85 Form	New
Form SSA-8552 SSA-8552 Form	New
Form SSA-4659 SSA-4659 Form	New
Form SSA-2932 SSA-2932 Form	New
Form SSA-2931 SSA-2931 Form	New
Chart Explaining the Changes to the 0960-0189 (2).doc Supplementary Document	2008-05-20
supporting_statement_--_0189_(F).doc Supporting Statement A	2008-02-27
Supporting Statement Part B--0189.doc Supporting Statement B	2008-02-26
Addendum--0189.doc Supplementary Document	2008-02-26

IC Document Collections

IC ID	Document Title	Status
9153	SSA-2930 Form	Modified
183776	SSA-2935 Form and Instruction	New
183775	SSA-85 Form	New
183774	SSA-8552 Form	New
183773	SSA-L8554-U3 Other-Notice	New
183772	SSA-L8553-U3 Other-Notice	New
183771	SSA-L8552-U3 Other-Notice	New
183770	SSA-L8551-U3 Other-Notice	New
183769	SSA-L8550-U3 Other-Notice	New
183268	SSA-4659 Form	New
183266	SSA-2932 Form	New
183264	SSA-2931 Form	New

ICR Details

OMB Control No: 0960-0189	ICR Reference No: 200801-0960-002
Status: Historical Active	Previous ICR Reference No: 200412-0960-012
Agency/Subagency: SSA	Agency Tracking No:
Title: Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/20/2008
	Date Received in OIRA: 02/28/2008
Terms of Clearance: Approved with addition of burden chart.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2011	36 Months From Approved	05/31/2008
Responses	12,075	0	5,475
Time Burden (Hours)	1,997	0	2,521
Cost Burden (Dollars)	0	0	0

---

Abstract: The information on Forms SSA–2930, SSA–2931 and SSA–2932 is used by the SSA to establish a national payment accuracy rate for all cases in payment status and to serve as a source of information regarding problem areas in the Retirement and Survivors Insurance (RI) and Disability Insurance (DIY) programs. The information is also used to measure the accuracy rate for newly adjudicated RI/DIY cases. SSA uses the information on form SSA–4659 to evaluate and determine the effectiveness of the annual earnings test and to use the results in developing ongoing improvements in the process. The respondents are a statistically valid sample of all RI/DIY beneficiaries in current pay status.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 428 Name of Law: null
   US Code: 42 USC 1382c Name of Law: null
   US Code: 42 USC 1395o Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 62510	11/05/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 10505	02/27/2008
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
SSA-2930	SSA-2930	RSI/DI Quality Review Case Analysis - Sampled Number Holder
SSA-2931	SSA-2931	RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors
SSA-2932	SSA-2932	RSI/DI Quality Review Case Analysis � Parent
SSA-4659	SSA-4659	Stewardship Annual Earnings Test Workbook
SSA-2935	SSA-2935	Authorization to the Social Security Administration to Obtain Personal Informaition
SSA-L8550-U3
SSA-L8551-U3
SSA-L8553-U3
SSA-L8554-U3
SSA-L8552-U3
SSA-85	SSA-85	Information Needed to Review Your Social Security Claim
SSA-8552	SSA-8552	Interview Confirmation

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	12,075	5,475	0	9,400	-2,800	0
Annual Time Burden (Hours)	1,997	2,521	0	785	-1,309	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Previously these forms were being used for two reviews: the Index of Dollar Accuracy (IDA) Review (2,500 cases selected) and the Stewardship Review (1,500 cases selected). The IDA review was for new awards and the Stewardship Review looks at any person in current pay on the record. We are no longer collecting information for the IDA Review which has caused a decrease in the number of respondents. Also, because the number of respondents for the Stewardship Review is dependent on how many individuals are on the current pay status record, the number of respondents for Stewardship Review can fluctuate. For instance, if a Number Holder (NH) and a spouse with a child were on the record, then one workbook would be used for the NH and another for the spouse and child (student). Therefore, two workbooks would be used for three respondents on the earnings statement. Because we cannot be certain that we will need more than one workbook per respondent at the time of selection, SSA has decided to report only the exact number of beneficiaries chosen for the Stewardship Review (1,500 cases) rather than add in the extra 300 cases which were previously added to account for the possibility that more than one individual may be listed on the record for any given respondent. We also show an increase due to a program change, as each respondent in current pay will receive an appointment notice for either a face-to-face review or a telephone review along with an SSA-85, an SSA-8552 and an SSA-2935. Previously, we did not include these notices as they did not request information from the public. Now that our notices request information, and we are also using three new forms to collect additional information, we are including them in this clearance request.

---

Annual Cost to Federal Government: $3,317

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/28/2008

---