View Information Collection Request (ICR) Package
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View Supporting Statement and Other Documents
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:
0960-0646
ICR Reference No:
201103-0960-016
Status:
Historical Active
Previous ICR Reference No:
200804-0960-003
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Teacher Questionnaire; Request for Administrative Information
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:
07/14/2011
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2014
36 Months From Approved
09/30/2011
Responses
797,000
0
1,233,000
Time Burden (Hours)
465,167
0
359,750
Cost Burden (Dollars)
0
0
0
Abstract:
When determining the effects of a child's impairment(s), SSA must obtain information about the child's functioning from teachers, parents, and others who have the opportunity to observe the child on a day-to-day basis. SSA obtains results of formal testing, teacher reports, therapy progress notes, Individualized Education Programs, and other records of a child's educational aptitude and achievement on the SSA-5665 and SSA-5666. The respondents are parents, teachers, and other Education personnel.
Authorizing Statute(s):
US Code:
42 USC 1382c
Name of Law: Social Security Act
US Code:
42 USC 1383b
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 19175
04/06/2011
30-day Notice:
Federal Register Citation:
Citation Date:
76 FR 38448
06/30/2011
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
SSA-5665-BK (electronic)
SSA-5665-BK (Electronic)
Teacher Questionnaire
SSA-5665-BK (paper)
SSA-5665-BK
Teacher Questionnaire
SSA-5666
SSA-5666
Request for Administrative Information
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
797,000
1,233,000
0
388,581
-824,581
0
Annual Time Burden (Hours)
465,167
359,750
0
259,054
-153,637
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:
There has been a decrease in burden hours. This change stems from a decrease in the number of child applications from birth to age 18. There has been in increase in burden hours. This change also stems from an increase in the completion time from 20 minutes to 40 minutes for form SSA-5665-BK, and 15 minutes to 30 minutes for form SSA-5666.
Annual Cost to Federal Government:
$167,720
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:
07/14/2011
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