View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0780
ICR Reference No:
201406-0960-010
Status:
Historical Active
Previous ICR Reference No:
201308-0960-004
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Centenarian Project and Medicare Non-Utilzation Project Development Worksheets: Face-to-Face Interview; Telephone Interview
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/23/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/15/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2016
06/30/2016
06/30/2016
Responses
16,000
0
42,000
Time Burden (Hours)
4,000
0
10,500
Cost Burden (Dollars)
0
0
0
Abstract:
SSA conducts interviews with Title XVI recipients age 100 and older, or Title II beneficiaries ages 90 and above who do not use their Medicare benefits for an extended period and who lack private insurance, a health maintenance organization (HMO), or a nursing home (which may indicate the individual is deceased) to: (1) assess if the beneficiaries are still living; (2) to prevent fraud, through either identity misrepresentation or representative payee misuse of funds; and (3) to evaluate the well being of the beneficiaries. SSA field office personnel obtain the information through one-time interviews with these individuals. If the individuals have representatives or caregivers, SSA personnel invite them to the interviews. During the interview, SSA employees make overall observations of the individual and their representative payee (if applicable). The interviewer uses the appropriate Development Worksheet as a guide for the interview, in addition to documenting findings during the interview. Non-completion of the Worksheets, or refusal of the interview, does not result in the suspension of the individual's payments. SSA conducts the interview either over the telephone or through a face-to-face discussion with the individual. This is a national project for our title II beneficiaries and title XVI recipients. Respondents are SSI recipients 100 years old or older; and Social Security beneficiaries ages of 90 and above who are not utilizing their Medicare benefits and lack private insurance, an HMO, or nursing home; their representative payees; or their caregivers. This non-substantive Change Request expands the current program to replace the current Title II Centenarian Project with the Medicare Non-Utilization Project (MNUP), and create a Title XVI only Centenarian Project. See Justification for the Non-Substantive Changes for further information.
Authorizing Statute(s):
US Code:
42 USC 405
Name of Law: The Social Security Act
US Code:
42 USC 1383
Name of Law: The Social Security Act
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:
77 FR 76591
12/28/2012
30-day Notice:
Federal Register Citation:
Citation Date:
78 FR 17276
03/20/2013
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Centenarian Project Title XVI Only
Medicare Non-utilization Project (MNUP)
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
16,000
42,000
0
-21,000
-5,000
0
Annual Time Burden (Hours)
4,000
10,500
0
-5,250
-1,250
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
We requesting to replace the current Title II Centenarian Project with the Medicare Non-Utilization Project, and make the Centenarian Project Title XVI only. We intend to implement this change by September 2014. See Justification for the Non-Substantive Changes for more information.
Annual Cost to Federal Government:
$185,573
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]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
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:
07/15/2014
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