View Information Collection Request (ICR) Package

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: 0960-0739	ICR Reference No: 200608-0960-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Certificate of Incapacity
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 with change	Conclusion Date: 01/04/2007
	Date Received in OIRA: 09/12/2006
Terms of Clearance: This ICR is approved on the following conditions: 1) SSA agrees to clarify its justification for why the expiration date for this OMB control number will not be printed on the forms (both in this and in future supporting statements); 2) SSA agrees to add a question about how long the child's condition is expected to last, given that one of the criteria for certifying a qualifying disability is that the disability will last for at least a year.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved
Responses	38	0	0
Time Burden (Hours)	29	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	38	38
Annual Time Burden (Hours)	29	29
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This burden increase is due to the fact that we are clearing a form that has been in existence for some time as a "bootleg" form -- i.e., it was inadvertantly being used without OMB approval.

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