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OMB Control No: 0960-0579	ICR Reference No: 200708-0960-002
Status: Historical Active	Previous ICR Reference No: 200704-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Report - Adult, 20 CFR 404.1512 and 416.912
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/01/2008
	Date Received in OIRA: 08/02/2007
Terms of Clearance: This ICR is approved consistent with the 12-19-07 memo and the agreed-upon revisions to the instrument to minimize respondent burden. Although this ICR has undergone numerous revisions in the past, the revisions have not been substantive enough to make previous editions obsolete. As per the 12-19-07 memo, previous versions of this form continue to be used until the stock is used up. For this reason, SSA is not required to print the expiration date for the OMB control number on these forms. However, should this form undergo more substantive changes in the future, SSA agrees to consider printing the expiration date on the forms.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2011	36 Months From Approved	01/31/2008
Responses	3,350,554	0	2,116,667
Time Burden (Hours)	3,552,823	0	2,257,667
Cost Burden (Dollars)	0	0	0

Abstract: The Disability Report-Adult collects medical and other evidence which is used to determine whether an adult's impairment is disabling, and consequently, if that adult is entitled to Title II and/or Title XVI disability payments from the Social Security Administration. The information can be collected through the following ways: a paper form, in an SSA field office, an Internet version, and a new Internet version designed to be completed by professional advocacy groups. The respondents are adult disability applicants or their representatives.

Authorizing Statute(s): US Code: 42 USC 1383
   US Code: 42 USC 423
   US Code: 42 USC 405

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 20154	04/23/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 32697	06/13/2007
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	3,350,554	2,116,667	1,233,887
Annual Time Burden (Hours)	3,552,823	2,257,667	1,295,156
Annual Cost Burden (Dollars)	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is an increase in the public reporting burden since this was last approved by OMB. The change is due to several factors. A major factor is that we have been able to compile more accurate data since we prepared the previous Supporting Statement. Other factors are increased use of the EDCS 3368, i3368 and i3368-PRO, and the additional time it takes respondents to use the i3368 and i3368-PRO over the time it takes for use of the EDCS 3368 and paper SSA-3368.

Annual Cost to Federal Government: $34,708,811

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

Agency Contact: Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov

View ICR - OIRA Conclusion