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OMB Control No: 0960-0579	ICR Reference No: 202508-0960-001
Status: Received in OIRA	Previous ICR Reference No: 202501-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Report - Adult
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 03/23/2026

	Requested	Previously Approved
Expiration Date	11/30/2026	11/30/2026
Responses	2,258,510	2,258,510
Time Burden (Hours)	5,163,963	3,387,766
Cost Burden (Dollars)	0	0

Abstract: State Disability Determination Services (DDS) use Form SSA-3368, Disability Report – Adult, and its electronic versions, to determine if an adult disability applicant’s impairment(s) is severe and, if so, how the impairment(s) affects the applicant’s ability to work. This determination dictates whether the DDS and SSA will find the applicant disabled. The information we collect on the SSA 3368 is used by the State Disability Determination Services (DDS) to obtain evidence and evaluate whether or not an individual is found disabled. The collection is mandatory for applicants filing to obtain Title II disability benefits or Title XVI Supplemental Security Income (SSI) payments. We collect this information from the individual one time. We collect the information via several modalities: the SSA-3368-BK PDF paper form, the EDCS SSA-3368 Intranet application, and the i3368 Internet application. The respondents complete the SSA-3368 by themselves with self help information available, or another may complete the paper form or electronic application on their behalf. The respondents generally do not need information from someone else to complete the application. The respondents are disability applicants or third parties assisting the applicants applying for Title II disability benefits or Title XVI SSI payments. We are submitting a non-substantive Change Request to include the Final Rule revisions currently approved under 0960-0834 (Intermediate Improvement to the Disability Adjudication Process, Including How We Consider Past Work) under this ICR. Upon OMB's approval of this Change Request (and the Change Requests for both 0960-0300 and 0960-0578), we will discontinue the ICR for 0960-0834 to avoid double-counting the burden for these information collections.

Authorizing Statute(s): US Code: 42 USC 205(a) Name of Law: The Social Security Act
   US Code: 42 USC 223(d)(5)(A) Name of Law: The Social Security Act
   US Code: 42 USC 1631(e)(1) Name of Law: The Social Security Act
   US Code: 42 USC 1631(d)(1) Name of Law: The 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:
	86 FR 46897	08/20/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 59262	10/26/2021
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 - Adult (EDCS Version)
Disability Report - Adult, (Fillable PDF)	SSA-3368
Disability Report - Adult, (Internet Version)

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	2,258,510	2,258,510	0
Annual Time Burden (Hours)	5,163,963	3,387,766	1,776,197
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: The burden changes reflected here are the same burdens we published in the currently approved ICR for 0960-0834 (Intermediate Improvement to the Disability Adjudication Process, Including How We Consider Past Work). We are moving them from 0960-0834 to this ICR, after which we will discontinue 0960-0834 to avoid double-counting the burden. * Note: The total burden reflected in ROCIS is 5,163,963, while the burden cited in the attached Justification for the Non-Substantive Changes is 3,011,347. This discrepancy is because the ROCIS burden reflects the following components: field office and telephone waiting time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in the Justification reflects actual burden.

Annual Cost to Federal Government: $49,426,830

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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