[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