View Information Collection Request (ICR) Package

OMB Control No: 0960-0499	ICR Reference No: 202408-0960-001
Status: Received in OIRA	Previous ICR Reference No: 202005-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Questionnaire for Children Claiming SSI Benefits
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 12/16/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2025
Responses	151,243	125,000
Time Burden (Hours)	246,905	103,125
Cost Burden (Dollars)	0	0

Abstract: Parents or legal guardians seeking to obtain or retain SSI eligibility for their children use Form SSA-3881-BK to provide SSA with the addresses of non medical sources such as schools, counselors, agencies, organizations, or therapists who have information about a child’s function. The adjudicative team (a disability examiner and a medical or psychological consultant) of the State disability determination services (DDS) office collects the information to help determine a child’s claim or continuing eligibility for SSI. The respondents are the parents, guardians, and other caretakers of applicants who appeal SSI childhood disability decisions, or of recipients undergoing a continuing disability review.

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:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 74351	09/12/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 97155	12/06/2024
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	151,243	125,000	26,243
Annual Time Burden (Hours)	246,905	103,125	143,780
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 information collection in 2021, the burden was 62,500 hours. However, we are currently reporting a burden of 75,622 hours. This change stems an increase in the number of responses from 125,000 to 151,243. 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. SSA is unable to breakdown the method in which the form was completed, whether it was completed electronically (internet) via in-office or telephone appointment or if it was a paper version submitted to the FO upon completion, which was then scanned into the electronic file. Therefore, unlike the information collection in 2021, this information collection is unable to precisely predict how many respondents physically traveled to the FO. At the prior information collection for this form (2021), we determined that approximately 65% of respondents visited the FO to submit a paper version of the SSA-3881-BK. We are continuing to use that data; however, we are still working on a better way to obtain more accurate data to make this estimate. * Note: The total burden reflected in ROCIS is 246,905, while the burden cited in #12 of the Supporting Statement is 75,622. 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 + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

Annual Cost to Federal Government: $2,127,813

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

View ICR - Agency Submission