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:
0960-0623
ICR Reference No:
201104-0960-003
Status:
Historical Active
Previous ICR Reference No:
200806-0960-010
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Authorization to Disclose Information to the Social Security Administration
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
05/27/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/08/2011
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2011
11/30/2011
11/30/2011
Responses
4,829,651
0
16,001,944
Time Burden (Hours)
722,330
0
864,329
Cost Burden (Dollars)
0
0
0
Abstract:
SSA must obtain sufficient medical evidence to make eligibility determinations for title II and title XVI payments. Therefore, the applicant must authorize their medical source(s) to release the information to SSA. The applicant may use form SSA-827 to provide consent for the release of information. Generally, the State DDS completes the form(s) based on information provided by the applicant, and sends the form(s) to the designated medical source(s).
Authorizing Statute(s):
US Code:
42 USC 1383
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 405
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:
73 FR 40005
07/11/2008
30-day Notice:
Federal Register Citation:
Citation Date:
73 FR 53919
09/17/2008
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Authorization To Disclose Information To The Social Security Administration / SSA-827 (sign and date only)
SSA-827
Authorization to Disclose Information to the Social Security Administration
Authorization to Disclose Information to the Social Security Administration (Internet Instructions)
Authorization to Disclose Information to the Social Security Administration / SSA-827
SSA-827
Authorization To Disclose Information To The Social Security Administration
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
4,829,651
16,001,944
0
-11,561,784
389,491
0
Annual Time Burden (Hours)
722,330
864,329
0
-192,696
50,697
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
SSA is reducing the burden by eliminating the need for three of the four signed SSA-827s (see the Justification for the Non-Substantive Changes). In addition, due to an increase in respondents, we increased the overall burden for the SSA-827. We also increased the burden for reading the Internet explanation of the SSA-827 as our data shows more people using the Internet to read the instructions for the form.
Annual Cost to Federal Government:
$23,740,196
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:
04/08/2011
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