TN 30 (03-02)

A. Description of Form SSA-4513

The Form SSA-4513 is used to report all obligations (liquidated and unliquidated) on quarterly basis from each State agency. The quarterly reports will report status of cumulative obligations from the beginning of the fiscal year to date of report.

Note: Separate forms SSA-4513 may be required to account for different funding categories (e.g., Automated Investment Funds, Information Technology System Funding, etc.).

See DI 39506.240 for instructions on reporting costs related to processing Federal Employee Medicare Only cases.

B. Procedure - form heading

Enter the name of the agency, State, fiscal year being reported, and the period (from October 1 of the fiscal year being reported through the end of the current calendar quarter).

C. Procedure - report columns

1. Column A (disbursements)

Enter cumulative disbursements through the ending date of the report period for each category listed.

2. Column B (unliquidated obligations)

Enter amounts of all unliquidated obligations as of the ending date of the report period for each category listed.

3. Column C (total obligations)

The total cumulative obligations should reflect the sum of column A (Disbursements) and column B (Unliquidated Obligations) as of the ending date of the report period.

D. Procedure - line item reporting

See categories below for line item reporting.

1. Personnel service costs

This line should reflect all wages and salaries paid to DDS personnel (full-time, part-time, and temporary) for time devoted exclusively to SSA disability programs--provided the charges to these programs are not derived through apportionment with another agency or component. Include fringe benefits and earnings of contracted medical consultants; however, exclude temporary personnel agency services or contract services and management consultants working on specific projects that are included under contracted costs.

2. Medical costs

Medical costs reflect the total costs incurred for the purchase of consultative examinations (CE) and medical evidence of records (MER) for all SSA disability programs (title II, title XVI, and concurrent). Do not report applicant travel in this line total; however, do include the costs of services and travel of consulting physicians who testify at hearings.

• The CE is an examination of an applicant by a licensed physician or psychologist at the DDS's request and expense. Some examples include medical examinations, psychiatric examinations, psychological evaluations and tests, vocational workshops, X-rays, and laboratory tests. For information regarding vocational work evaluations, see DI 22511.007.

• MER is defined as document(s) received from a licensed physician, psychologist, clinic, hospital, or other providers of medical services for the purpose of documenting disability claims. In addition, the costs in obtaining school records for childhood disability claims should be included under MER costs.

NOTE: Costs associated with DDS personnel securing evidence of record directly from the custodian are not to be included in MER costs. For example, a DDS employee travels weekly to hospital X and clinic Y to photocopy medical records. Clinic Y does not have a photocopy machine so the DDS employee must bring a portable copier. The costs of the employee's time, travel and purchase of the portable copier are not to be included in MER costs. The employee's time is a personnel cost, travel is an employee travel cost, and the portable copier is an equipment cost. If hospital X charges for the use of their copy machine, this would be an MER cost. If, rather than a DDS employee, the DDS contracts out the functions of copying reports, these copies are “contracting out” costs.

3. Indirect costs

DDSs must report--on line 3 of the SSA-4513--all indirect costs that the State government has charged against the disability program for costs incurred during the period covered by the report. This should include the stated dollar amount or the amount derived by applying to the specified base the percentage authorized in the State department or parent agency's approved indirect cost proposal.

4. All other non-personnel costs

The categories for “All Other Non-personnel Costs” include the following:

1. Occupancy costs

   Obligations for occupancy include rental costs for office space occupied by the DDS, building maintenance costs, utility costs (heat, light, and water), leasehold improvement costs, building security (security guards), trash removal, cleaning, and pest control.

2. Contracting out costs (see DI 39542.000)

   Obligations for contracting out include acquisition of services normally performed by DDS personnel (e.g., medical transcription, word/voucher processing, temporary agency services, non-EDP equipment maintenance contracts, etc.). Exclude:

   • medical consultants which are included in personnel costs,

   • building maintenance contracts which are related to occupancy costs, and

   • hardware/software maintenance contracts which are related to EDP maintenance costs.

3. EDP maintenance costs

   EDP maintenance costs are those non-personnel costs associated with the operation of electronic data processing systems and include:

   • EDP maintenance charges and/or contracts

   • computer service center charges

   • programming services

4. New EDP equipment/upgrades (see DI 39536.000)

   New EDP equipment/upgrades are those non-personnel costs associated with the acquisition of electronic data processing systems.

   The DDS has $10,000 annual authority to purchase EDP equipment/upgrades provided the items do not fall within equipment/upgrades provided through Federal procurement contracts.

   • Costs included

     -central processing unit purchases or upgrades

     -printers

     -disk drives

     -all costs associated with a new automated system, excluding personnel costs (e.g., site modifications, modular furniture, training, travel, occupancy, etc.).

     -and other new/upgraded hardware and software applications requirements

   • Costs not included

     Hardware/software provided to the State DDSs by SSA through Federal procurement contracts.

5. Equipment costs (see DI 39530.000)

   Equipment is any article of tangible personal property (other than EDP equipment/upgrades) that has a life of more than 1 year, an acquisition cost of $5,000 or more per unit, and a probable resale, salvage, or trade-in value. In those instances where the acquisition cost of equipment in State law, regulation, or practice is lower than the foregoing, the State definition is applicable. The $5,000 includes applicable taxes, delivery, and installation charges. If equipment maintenance is billed or contracted separately, it should be reported under contracting out

   • Purchased equipment

     Purchased equipment includes such things as office furniture and furnishings, reproducing, dictating, transcribing, security equipment, telephone systems, and postage machines.

   • Rental equipment

     Rental equipment includes such things as office furniture and furnishings, reproducing, dictating, transcribing, and security equipment. Rental of telephone is reported under communications.

     NOTE: Equipment acquired under lease-purchase agreements is reported as rental equipment until purchased. SSA approval is required before entering into a lease/purchase agreement. Additionally, the DDS must obtain SSA approval for the conversion from a lease/purchase agreement to a purchase agreement.

6. Communication costs

   Communication costs consist of telecommunications and postage costs included in the administration of the SSA disability programs.

   • Telecommunications costs

     • telephone and line charges for data transmission

     • telephone line and service charges

     • telephone equipment rental

   • Postage and delivery costs (excluding Federal postage meter):

     • postage and box rental costs

     • contracted delivery services

     • freight charges (not related to purchases of furniture, equipment, and supplies)

     • other delivery charges (e.g., Federal Express)

7. Applicant travel costs (see DI 39525.000)

   Applicant travel costs are those costs associated with the applicant's travel and subsistence expenses in connection with reporting for CEs, vocational workshops, disability hearings, and prototype claimant conferences.

8. DDS travel costs (see DI 39524.000)

   DDS travel Costs are the sum of in-State and out-of-state costs associated with the travel of State agency personnel in the execution of the disability determination function.

9. Supplies (see DI 39539.000)

   • office supplies

   • printing and printed materials

   • reproduction paper and supplies

   • stationery

   • data processing paper and supplies

   • word processing paper and supplies

   • in-house training materials

   Note: Items of equipment with an acquisition cost of less than $5,000 are considered to be supplies.

10. Miscellaneous costs (see DI 39548.000)

    Miscellaneous costs are all other non-personnel costs that have not been previously identified and reported elsewhere. This includes such items as:

    • training in outside resources,

    • move and relocation costs,

    • automobile and liability insurance, and

    • direct charges from other State agencies not included in indirect cost allocation agreements or reported elsewhere.

Training costs will be reported in the miscellaneous category. Training costs are those costs that arise in relation to the training of DDS personnel, and involve resources that are outside the DDS, parent agency, or SSA. This includes such items as tuition costs, books, fees, and instructor costs (including instructor travel costs). Costs for employee travel associated with training activities are not included in training costs, but are associated under DDS travel costs.

5. Total

This line should reflect the total personnel services costs, medical costs, indirect costs, and all other non-personnel costs (the sum of entries in lines 1 through 4 on Form SSA-4513).

6. Cumulative obligational authorization

Enter the total amount reflected on the latest SSA-872 authorized for the reporting period.

7. SSA-871 attached? (yes/no)

Check appropriate box to indicate whether form SSA-871 will be attached.

8. Signature/Title/Date

The form must be signed by the person (name and official title) authorized to submit estimates of anticipated costs and reports of actual expenditures on the SSA-4513. (See DI 39506.280 for instructions on acceptable certificate of authority.)