View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0960-0540	ICR Reference No: 202112-0960-006
Status: Active	Previous ICR Reference No: 201810-0960-012
Agency/Subagency: SSA	Agency Tracking No:
Title: Pain Report - Child
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: 10/23/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/25/2022
Terms of Clearance: Prior to resubmission, the agency will revise Question Prompt #2 of Supporting Statement A to better contextualize the process of collecting and submitting this information consistent with user journey approach described in M-22-10 (Section 1.1). To that extent the agency will ensure the Supporting Statement A details how a respondent is informed of the need to complete this form, when the information is collected (e.g. whether is it during an existing transaction point in which multiple forms are completed), which forms are completed prior to this information collection that would normally trigger requesting submission of this information collection, and how the information is collected (e.g. oral interviews at a field office vs. written response).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2026	36 Months From Approved	10/31/2023
Responses	1,500	0	250,000
Time Burden (Hours)	1,725	0	62,500
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,500	250,000	-248,500
Annual Time Burden (Hours)	1,725	62,500	-60,775
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 62,500 hours. However, we are currently reporting a burden of 1500 hours. This change stems a decrease in the number of responses from 250,000 to 1,500. This decrease stems from a decrease in the number of respondents completing Form SSA-3371. 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 1,725, while the burden cited in #12 of the Supporting Statement is 375. 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: $86,520

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