View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0960-0347	ICR Reference No: 202112-0960-005
Status: Historical Active	Previous ICR Reference No: 201809-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Response to Notice of Revised Determination
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: 12/07/2023
	Date Received in OIRA: 02/25/2022
Terms of Clearance: Prior to triannual renewal, the agency will revise Question Prompt #2 of Supporting Statement A to provide more detail regarding the use of this form. In providing more detail, the agency will clarify how this form is distinct from other forms used to request reconsideration. The agency will provide more discussion of the context in which SSA would initiate an action that leads to a revised determination and how that process is distinct from other types of processes the agency undertakes to re-evaluate if a claimant or beneficiary is still eligible for benefits (such as continuing disability review or redeterminations). In this revised response to Question Prompt #2, the agency will also estimate the number of individuals who receive "revised determination" notices each year to help provide better context to the number of respondents who ultimately complete and submit information under this collection..

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2026	36 Months From Approved	12/31/2023
Responses	1,925	0	1,925
Time Burden (Hours)	2,695	0	963
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,925	1,925	0
Annual Time Burden (Hours)	2,695	963	1,732
Annual Cost Burden (Dollars)	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: When we last cleared this IC in 2019, the burden was 963 hours. However, we are currently reporting a burden of 26 hours. This change stems a decrease increase in the number of responses from 1,925 to 963. This decrease stems from fewer respondents completing Form SSA-765. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. * Note: The total burden reflected in ROCIS is 2,695, while the burden cited in the attached Supporting Statement is 26. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

Annual Cost to Federal Government: $4,313

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

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? No

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

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