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: 0960-0579	ICR Reference No: 200904-0960-012
Status: Historical Active	Previous ICR Reference No: 200901-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Report - Adult
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: 11/06/2009
	Date Received in OIRA: 07/31/2009
Terms of Clearance: As a condition of OMB's approval of this ICR, SSA agrees to destroy its entire stock of the prior SSA-3368 form. In addition, SSA agrees that it will make no further revisions to the SSA-3368 (OMB 0960-0579) within the three year period for which its approved. In agreeing to this condition, SSA will be allowed to use the paper form for the three-year period without printing an expiration date.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved	02/28/2011
Responses	2,592,034	0	3,350,554
Time Burden (Hours)	2,757,163	0	3,552,823
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	2,592,034	3,350,554	10,218	-768,738
Annual Time Burden (Hours)	2,757,163	3,552,823	15,327	-810,987
Annual Cost Burden (Dollars)	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We realized upon obtaining the burden hour information for Fiscal Year 2008 that we used inaccurate figures in the last OMB clearance package for each version of the SSA-3368. Further information about this correction is available in the addendum. Additionally, we are discontinuing the i3368PRO upon full implementation of the revised information collection and the i3368 will absorb the former i3368PRO users. We will rollout the new i3368 over several weeks before completing the full implementation (see Addendum for more information).

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