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:
0960-0499
ICR Reference No:
201304-0960-005
Status:
Historical Inactive
Previous ICR Reference No:
201102-0960-001
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Questionnaire for Children Claiming SSI Benefits
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:
Preapproved
Conclusion Date:
08/23/2013
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/06/2013
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2014
08/31/2014
08/31/2014
Responses
152,000
0
152,000
Time Burden (Hours)
76,000
0
76,000
Cost Burden (Dollars)
0
0
0
Abstract:
Non-substantive change to the collection instrument Form SSA-3881-BK; revising words mental retardation to intellectual disability; no change in burden data. When 1) child claimants for Supplemental Security Income (SSI) benefits receive an unfavorable disability eligibility decision, and the people applying on their behalf want to appeal the decision; or 2) when children are currently receiving Disabled Child (DC) payments and the Social Security Administration (SSA) is reviewing their continued eligibility, these disability applicants and recipients need a mechanism to submit relevant evidence about the child's functioning. SSA uses Form SSA-3881, the Questionnaire for Children Claiming SSI Benefits, for that purpose. The respondents are parents or legal guardians of the child disability applicants/recipients.
Authorizing Statute(s):
US Code:
42 USC 1383
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Final or interim final rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
76 FR 5233
01/28/2011
30-day Notice:
Federal Register Citation:
Citation Date:
76 FR 18290
04/01/2011
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Questionnaire for Children Claiming SSI Benefits
SSA-3881 BK
ICR Summary of Burden
Total Request
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
152,000
152,000
0
0
0
0
Annual Time Burden (Hours)
76,000
76,000
0
0
0
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:
No
Burden Reduction Due to:
Short Statement:
Due to budgetary constraints, SSA has been conducting fewer disability reviews; thus the decrease in the overall reporting burden.
Annual Cost to Federal Government:
$1,558,480
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:
08/06/2013
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