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:
0960-0577
ICR Reference No:
202402-0960-001
Status:
Historical Active
Previous ICR Reference No:
201906-0960-006
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Disability Report - Child
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:
02/22/2024
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/12/2024
Terms of Clearance:
Any unsatisfied terms of clearance remain in effect.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2026
02/28/2026
02/28/2026
Responses
355,144
0
355,144
Time Burden (Hours)
621,502
0
621,502
Cost Burden (Dollars)
0
0
0
Abstract:
SSA uses Form SSA-3820-BK to collect information about a child’s condition from treating sources or other medical sources of evidence. The State Disability Determination Services (DDS) evaluators use the information from Form SSA-3820-BK to develop medical and school evidence, and to assess the alleged disability. The information, together with medical evidence, forms the evidentiary basis upon which SSA makes its initial disability evaluation. The respondents are claimants seeking SSI childhood disability payments. Applicants can complete and print Form SSA-3820-BK and mail to SSA, or take the notification page (generated after completing the i3820) to their local Social Security field office (FO). The notification page serves as a back-up alert to the FOs that an applicant transmitted an internet disability report. When claimants do not complete an i3820, FO employees use the Electronic Disability Collect System (EDCS) internal collection process to key information provided by claimants onto EDCS screens to establish a database for the DDS adjudicators. We are revising language on the SSA-3820-BK and the i3820 Internet application screens to change Mental Health/Retardation Center to Mental health/Developmental Disabilities Center due to a statuary change in terminology, to ensure consistency with the agreed upon revisions from the previous approval, and also comply with OMB's Terms of Clearance on this ICR.
Authorizing Statute(s):
US Code:
42 USC 423
Name of Law: Social Security Act
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:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
84 FR 31972
07/03/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 48694
09/16/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Disability Report - Child (EDCS)
Disability Report - Child (Internet)
Disability Report - Child (Paper) SSA-3820
SSA-3820-BK
Disability Report - Child
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
355,144
355,144
0
0
0
0
Annual Time Burden (Hours)
621,502
621,502
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:
When we last cleared this IC in 2016, the burden was 659,431 hours. However, we are currently reporting a burden of 621,502 hours. This change stems a decrease in the number of responses from 659,431 to 621,502. 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.
Annual Cost to Federal Government:
$751,220
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
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:
02/12/2024
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