[Federal Register Volume 60, Number 77 (Friday, April 21, 1995)]
[Notices]
[Pages 19951-19953]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-9909]
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SOCIAL SECURITY ADMINISTRATION
Agency Forms Submitted to the Office of Management and Budget for
Clearance
Normally on Fridays, the Social Security Administration publishes a
list of information collection packages that have been submitted to the
Office of Management and Budget (OMB) for clearance in compliance with
Public Law 96-511, The Paperwork Reduction Act. The following clearance
packages have been submitted to OMB since the last list was published
in the Federal Register on Friday, April 7, 1995.
(Call Reports Clearance Officer on (410) 965-4142 for copies of
package.)
1. Measuring Public Perception of the Value of Social Security--
0960-0551. The information on these questionnaires is used by the
Social Security Administration (SSA) to measure public perception of
the value of Social Security and to determine whether the Personal
Earnings and Benefit Statement (PEBES) affects public confidence in
Social Security. The control group respondents are members of the
general public who have not received an SSA-initiated PEBES. The study
group respondents are members of the general public who have received
recently an SSA-initiated PEBES.
SSA has requested and received expedited approval for this
collection of information (both the study group collection instrument
and the control group collection instrument) from OMB and is,
accordingly, publishing in the Federal Register a copy of each of the
collection instruments (5 CFR 1320.18(g)).
Number of Respondents: 6,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 1,500 hours
OMB Desk Officer: Laura Oliven
Written comments and recommendations regarding these information
collections should be sent directly to the appropriate OMB Desk Officer
designated above at the following address: Office of Management and
Budget, OIRA, New Executive Office Building, Room 10230, Washington, DC
20503.
Dated: April 17, 1995.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
Measuring Public Perception of the Value of Social Security (Control
Group)
Your Name--------------------------------------------------------------
Your Social Security Number ______-____-________
1. Are you aware that Social Security pays benefits (circle all that
you are aware of):
a. To you when you retire?
b. To you if you became disabled?
c. To your spouse if you became disabled or retired?
d. To your young children if you became disabled or retired?
e. To your widow if you should die?
f. To your young children should you die?
2. How important is it for you to plan financially for your
retirement?
a. Very important
b. Somewhat important [[Page 19952]]
c. Not important
3. Which of the following statements best describes the way the
Social Security retirement program works?
Social Security benefits provide:
a. A retirement income, which is enough by itself to meet the
living expenses of retired people.
b. A partial retirement income, which must be combined with
other source(s) of income to meet the living expenses of retired
people.
4. Do you have any source of income protection other than Social
Security if you have to stop working because of a disability?
a. Yes
b. No
c. Don't know
5. Do you have any source of financial protection for your survivors
other than Social Security should you die?
a. Yes
b. No
c. Don't know
6. How would you rate the importance of Social Security benefits in
your life?
a. Very important
b. Important
c. Not at all important
d. No opinion
Comments:------------------------------------------------------------
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7. How confident are you that Social Security benefits will be able
to meet your future financial needs?
a. Very confident
b. Somewhat confident
c. Not confident
d. No opinion
Comments:------------------------------------------------------------
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8. How would you rate your level of confidence in the following?
a. The economy
1. Very confident
2. Confident
3. Somewhat confident
4. Not at all confident
5. No opinion
b. The future prosperity of the United States
1. Very confident
2. Confident
3. Somewhat confident
4. Not at all confident
5. No opinion
c. The way the federal government is run
1. Very confident
2. Confident
3. Somewhat confident
4. Not at all confident
5. No opinion
9. What types of income do you plan to rely on when you retire?
(Circle all that apply)
a. Social Security benefits
b. Employer sponsored pension
c. Spouse's pension
d. Savings bonds
e. Other savings (includes certificates of deposit, IRAs, etc.)
f. Stocks, bonds, and/or mutual funds
g. Income from children
h. Earnings from part-time employment
i. Benefits from other government programs
j. Other sources. Specify________________
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10. Overall, how confident are you that you will have sufficient
funds to meet your retirement needs?
a. Highly confident
b. Somewhat confident
c. Not at all confident
Comments:------------------------------------------------------------
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11. How important is Social Security as a source of income in your
retirement?
a. Only source
b. Major source
c. Minor source
d. Not a source at all
e. Don't know
Comments:------------------------------------------------------------
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12. Would you find it helpful in planning your retirement to get an
estimate of the amount of benefits Social Security will pay you each
month when you retire?
a. Yes
b. No
c. Don't know
13. Did you know that you could request this information from Social
Security?
a. Yes
b. No
14. Have you ever requested a Personal Earnings and Benefit Estimate
Statement from Social Security?
a. Yes
b. No
c. Don't know
15. Would you describe yourself as:
a. Professional
b. Business manager or executive
c. Service worker
d. Clerical and sales
e. Skilled worker
f. Unskilled worker
g. Farmer
h. Housewife
i. Retired
j. Unemployed, not working
k. Student
l. Disabled
m. Something else. Specify:________________
Measuring Public Perception of the Value of Social Security
1. Within the past 2 weeks do you recall receiving a Personal
Earnings and Benefit Estimate Statement from Social Security?
a. Yes
b. No
c. Don't remember
(If b or c, STOP. Do not answer the remaining questions.)
2. After receiving the statement, did you:
a. Read all or almost all of the statement?
b. Read some or a little? (If read all or some, go to Q.4)
c. Read none?
3. What was the main reason you did not read it?
a. Not interested
b. Too hard to understand
c. No time
d. Other
Skip to Q.7.
4. How much of the information that you read was easy to understand?
a. All
b. Most
c. A little
d. None
Comments:------------------------------------------------------------
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5. After reading over the statement, do you think the information
was valuable to you and your family?
a. Yes, of significant value
b. Yes, of some value
c. No value
d. Don't know
Comments:------------------------------------------------------------
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6. Before you received the statement, were you aware that Social
Security paid benefits (circle all that you were aware of before you
read the statement):
a. To you when you retire?
b. To you if you become disabled?
c. To your spouse if you became disabled or retired?
d. To your young children if you became disabled or retired?
e. To your widow if you should die?
f. To your young children should you die?
7. How important is it for you to plan financially for your
retirement?
a. Very important
b. Somewhat important
c. Not important
8. Which of the following statements best describes the way the
Social Security retirement program works?
Social Security benefits provide:
a. A retirement income, which is enough by itself to meet the
living expenses of retired people.
b. A partial retirement income, which must be combined with
other source(s) of income to meet the living expenses of retired
people.
9. The Personal Earnings and Benefit Estimate Statement shows an
estimate of the amount of benefits you will receive when you retire.
Did you read the part of the statement that explains the estimate?
a. Yes
b. No (If No, skip to Q. 12)
10. Would you say the amount shown was:
a. About what I expected
b. More than I expected
c. Less than I expected
Comments:------------------------------------------------------------
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[[Page 19953]] -------------------------------------------------------
11. Based on the estimate for your retirement benefits given on your
statement, would you say that the amount of retirement benefits is:
a. Generous
b. Adequate
c. Inadequate
d. Not sure
Comments:------------------------------------------------------------
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12. Do you have any source of income protection other than Social
Security if you have to stop working because of a disability?
a. Yes
b. No
c. Don't know
13. Do you have any source of financial protection for your
survivors other than Social Security should you die?
a. Yes
b. No
c. Don't know
14. How would you rate the importance of Social Security benefits in
your life?
a. Very important
b. Important
c. Not at all important
e. No opinion
Comments:------------------------------------------------------------
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15. How confident are you that Social Security benefits will be able
to meet your future financial needs?
a. Very confident
b. Somewhat confident
c. Not confident
d. No opinion
Comments:------------------------------------------------------------
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16. How would you rate your level of confidence in the following?
a. The economy
1. Very confident
2. Confident
3. Somewhat confident
4. Not at all confident
5. No opinion
b. The future prosperity of the United States
1. Very confident
2. Confident
3. Somewhat confident
4. Not at all confident
5. No opinion
c. The way the federal government is run
1. Very confident
2. Confident
3. Somewhat confident
4. Not at all confident
5. No opinion
17. What types of income do you plan to rely on when you retire?
(Circle all that apply)
a. Social Security benefits
b. Employer sponsored pension
c. Spouse's pension
d. Savings bonds
3. Other savings (include certificates of deposit, IRAs, etc.)
f. Stocks, bonds, and/or mutual funds
g. Income from children
h. Earnings from part-time employment
i. Benefits from other government programs
j. Other sources. Specify________________
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18. Overall, how confident are you that you will have sufficient
funds to meet your retirement needs?
a. Highly confident
b. Somewhat confident
c. Not at all confident
Comments:------------------------------------------------------------
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19. How important is Social Security as a source of income in your
retirement?
a. Only source
b. Major source
c. Minor source
d. Not a source at all
e. Don't know
Comments:------------------------------------------------------------
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20. Would you describe yourself as:
a. Professional
b. Business manager or executive
c. Service worker
d. Clerical and sales
e. Skilled worker
f. Unskilled worker
g. Farmer
h. Housewife
i. Retired
j. Unemployed, not working
k. Student
l. Disabled
m. Something else (Specify: ____________)
Privacy and Paperwork Reduction Act Notice: We are allowed to
collect the information on this survey under Sections 205 and 1143
of the Social Security Act. Giving us this information is voluntary.
We will use your answers, along with the answers of other people who
are part of the survey, to measure public perception of the value of
Social Security programs and the benefit of receiving a Personal
Earnings and Benefit Estimate Statement. We will not use the
information on this form for any other purpose.
Time it Takes to Complete This Form: We estimate it will take
you about 15 minutes to complete this survey. This includes the time
it will take to read the instructions, gather the necessary facts
and fill out the form. If you have any comments or suggestions on
this estimate, or on any other aspect of this form, write to the
Social Security Administration, ATTN: Reports Clearance Officer, 1-
A-21 Operations Bldg., Baltimore, MD 21235-0001. Send only comments
relating to our estimate or other aspects of this form to the office
listed above. All requests for Social Security cards and other
claims-related information should be sent to your local Social
Security Office, whose address is listed in your telephone directory
under the Social Security Administration.
[FR Doc. 95-9909 Filed 4-20-95; 8:45 am]
BILLING CODE 4190-29-P
