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:
201103-0960-011
Status:
Historical Active
Previous ICR Reference No:
200708-0960-016
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:
09/30/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/28/2011
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2014
36 Months From Approved
09/30/2011
Responses
16,103,000
0
7,553,000
Time Burden (Hours)
2,859,083
0
1,803,560
Cost Burden (Dollars)
0
0
0
Abstract:
State disability determinations services collect the information SSA needs to administer its disability program. For the purposes of this ICR, we divide this information into three categories: 1) consultative examination (a/b/c); 2) medical evidence of record; and 3) pain/other symptoms/impairment. Respondents are individuals, private sector, and State and local governments.
Authorizing Statute(s):
US Code:
42 USC 405
Name of Law: Social Security Act
US Code:
42 USC 423
Name of Law: Social Security Act
US Code:
42 USC 1382c
Name of Law: Social Security Act
US Code:
42 USC 1383
Name of Law: Social Security Act
US Code:
42 USC 421
Name of Law: Social Security Act
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:
76 FR 16849
03/25/2011
30-day Notice:
Federal Register Citation:
Citation Date:
76 FR 41320
07/13/2011
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
Category I , CE a) Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category)
Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")
N/A
Sample CE Forms
Category I, CE a) Medical Evidence from CE Providers (Electronic Transmission through ERE; subset of "CE Forms Samples" category)
Category I, CE b) Claimant/Appointment Letter Information (subset of "CE Forms Samples" category)
Category I, CE c) Claimants re Report to Medical Provider (subset of "CE Forms Samples" category)
Category II - MER Paper Submissions (subset of "MER Samples") category
Category II - MER, ERE & Connect Direct transmission of MER forms (subset of "MER Samples" category)
Category III - Pain/Other Symptoms/Impairment Information
Pain Questionnaire
Pain Questionnaire
Connect Direct Transmission of MER Information (subset of "MER Samples" category)
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
16,103,000
7,553,000
0
-218,400
8,768,400
0
Annual Time Burden (Hours)
2,859,083
1,803,560
0
153,733
901,790
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:
Yes
Burden Reduction Due to:
Changing Forms
Short Statement:
The burden decreased because we combined the two methods of electronic submissions into one instrument for MER electronic submissions. The burden also decreased under response times for the ICI CE(a)medical evidence electronic submission as a result of respondents becoming more familiar/quicker with electronic submissions. The burden increased under all MER ICIs due to the addition of a treatment source questionnaire as part of the MER ICI, thus increasing the overall respondents' response time.
Annual Cost to Federal Government:
$550,000,000
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]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@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:
07/28/2011
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