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OMB Control No: 0960-0803	ICR Reference No: 202301-0960-002
Status: Active	Previous ICR Reference No: 201904-0960-013
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement From Excluded Medical Sources of Evidence
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: 07/10/2023
	Date Received in OIRA: 06/06/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	36 Months From Approved	09/30/2023
Responses	600	0	3,000
Time Burden (Hours)	200	0	1,000
Cost Burden (Dollars)	0	0	0

Abstract: Section 812 of the Bipartisan Budget Act of 2015 (BBA), ‘‘Exclusion of certain medical sources of evidence,’’ mandates that SSA exclude evidence in disability decisions from certain medical sources. BBA Section 812 amended section 223(d)(5) of the Social Security Act (Act) by adding a subsection ‘‘C.’’ Section 223(d)(5)(C)(i) of the Act, as amended, requires SSA to exclude evidence (except for good cause) from medical sources: (1) convicted of a felony under sections 208 or 1632 of the Act; (2) excluded from participating in any Federal health care program under section 1128 of the Act; or (3) imposed with a civil monetary penalty (CMP), assessment, or both, for submitting false evidence, under section 1129 of the Act. We also implemented section 223(d)(5)(C), as amended, through regulations at 20 CFR 404.1503b and 416.903b of the Code of Federal Regulations. These regulations require excluded medical sources to self-report their excluded status, in writing, each time they submit evidence related to a claim for benefits under Titles II or XVI of the Act. Excluded medical sources’ duty to self-report their excluded status applies to evidence they submit to SSA directly, or through a representative, claimant, or other individual or entity. As needed, SSA informs the medical sources we suspect should be excluded of these requirements through a Fact Sheet we send to them via mail, or which they can find on our website where we list the regulatory requirements under BBA section 812. In addition, along with the Fact Sheet and website, we provide sample statements as templates which the affected medical sources can use to create their own written statements as required under our regulations. The respondents for this collection are medical sources that: (1) meet one of the exclusionary categories set forth in section 223(d)(5)(C)(i) of the Act, as amended; (2) furnish evidence related to a claim for benefits under Titles II or XVI of the Act; and (3) had failed to self-identify as an excluded source of medical evidence as required in Section 223(d(5)(C)(i).

Authorizing Statute(s): US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
   PL: Pub.L. 114 - 74 812 Name of Law: Bipartisan Budget Act of 2015
   US Code: 42 USC 902 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act

Citations for New Statutory Requirements: PL: Pub.L. 114 - 74 812 Name of Law: Bipartisan Budget Act of 2015

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:
	88 FR 10614	02/21/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 35990	06/01/2023
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
20 CFR 404.1503b(c) & 416.903b(c)

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	600	3,000	-2,400
Annual Time Burden (Hours)	200	1,000	-800
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 2020, the burden was 1,000 hours. However, we are currently reporting a burden of 200 hours. This stems from an overall decrease in the number of respondents who are not familiar with the rules we implemented in 2019, resulting in fewer respondents per year who we need to contact for this information collection (as most of those medical sources affected by these rules already submit medical evidence to us with the requisite statement). SSA continues to observe fewer excluded sources who submit evidence as the years progress. This pattern explains why the numbers described above have decreased over time. In addition, we also changed the frequency of response to show an average of 3 responses per respondent who is subject to these regulations. These revisions stem from our current management information data which shows the current number of responses and frequency of response for this information collection.

Annual Cost to Federal Government: $22,488

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. No

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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