View Information Collection Request (ICR) Package
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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:
0960-0566
ICR Reference No:
199612-0960-003
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Privacy and Disclosure of Official Records and Information, Availability of Information and Records to the Public -- 20 CFR 401 and 402
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
02/04/1997
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/05/1996
Terms of Clearance:
This information collection is approved through 2-2000 under the following conditions: this submission was modified to remove the "consent for release of information form." After submitting this information collection, SSA requested a separate emergency clearance for the consent form under OMB number 0960-0567. In addition, SSA will publish two corrections to the rule in the Federal Register. The Paperwork Reduction Act section of the rule incorrectly notes that the SSA has submitted the collection requirements under section 3507(d). This should be 3507 (c). SSA will publish a corrected 12866 section that indicates that SSA determined the rule was not significant, as OMB did not have the opportunity to make such a determination. Finally, SSA will reexamine recent changes in Privacy Act case law to ensure that these collections continue to have practical utility.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/29/2000
02/29/2000
Responses
28,500
0
0
Time Burden (Hours)
9,133
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The information is needed to identify individuals who request access to their records, to designate an individual to receive and review sensitive medical records, to correct or amend records, to obtain consent from an individual to release his/her records to others, to facilitate the release of information under the Freedom of Information Act, and to grant a waiver or reduction of fees for records. The respondents are individuals requesting access to their SSA records, correction of their SSA records, and disclosure of their SSA records.
Authorizing Statute(s):
None
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Privacy and Disclosure of Official Records and Information, Availability of Information and Records to the Public -- 20 CFR 401 and 402
SSA-3288
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
28,500
0
0
28,500
0
0
Annual Time Burden (Hours)
9,133
0
0
9,133
0
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:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$0
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:
12/05/1996
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