View Information Collection Request (ICR) Package
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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:
0960-0555
ICR Reference No:
200708-0960-016
Status:
Historical Active
Previous ICR Reference No:
200703-0960-002
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Clearance of Information Collections Conducted by State Disability Determination Services on Behalf of SSA
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
08/15/2008
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/30/2008
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2011
36 Months From Approved
05/31/2010
Responses
7,553,000
0
6,553,000
Time Burden (Hours)
1,803,560
0
1,553,560
Cost Burden (Dollars)
0
0
0
Abstract:
The information collections are conducted in support of SSA's disability programs. The consultative exam (CE) report medical evidence of record and pain report are used in the determination of disability. The information collected from potential CE providers is used to verify the providers' credentials and licenses. The information collected from claimants is used to obtain release of medical information and to confirm scheduled CE appointments. The respondents are medical provider and claimants for disability.
Authorizing Statute(s):
US Code:
42 USC 423
US Code:
42 USC 1382c
US Code:
42 USC 405
US Code:
42 USC 1383
US Code:
42 USC 421
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:
73 FR 1253
01/07/2008
30-day Notice:
Federal Register Citation:
Citation Date:
73 FR 21400
04/21/2008
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
9
IC Title
Form No.
Form Name
CE Claimant/Appointment Letter Information (subset of "CE Forms Samples" category)
CE Source Credentialing Information (Subset of "CE Sample Forms")
N/A
Sample CE Forms
Claimants re Report to Medical Provider (subset of "CE Forms Samples" category)
Connect Direct Transmission of MER Information (subset of "MER Samples" category)
ERE transmission of MER forms (subset of "MER Samples" category)
MER Paper Submissions (subset of "MER Samples") category
Medical Evidence from CE Providers (Electronic Transmission through ERE; subset of "CE Forms Samples" category)
Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category)
Pain Questionnaire
Pain Questionnaire
Pain Questionnaire
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
7,553,000
6,553,000
0
1,000,000
0
0
Annual Time Burden (Hours)
1,803,560
1,553,560
0
250,000
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:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The total burden for this collection has been increased by 250,000 hours. This increase is due to the inclusion of pain/symptoms information.
Annual Cost to Federal Government:
$436,000,000
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
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:
05/30/2008
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