View Information Collection Request (ICR) Package

OMB Control No: 0960-0577	ICR Reference No: 202602-0960-004
Status: Received in OIRA	Previous ICR Reference No: 202411-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Report - Child
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 02/23/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2026
Responses	353,236	710,288
Time Burden (Hours)	1,281,471	627,421
Cost Burden (Dollars)	0	0

Abstract: Sections 223(d)(5)(A) and 1631(e)(1) of the Act require Supplemental Security Income (SSI) claimants to furnish medical and other evidence to prove they are disabled. SSA uses Form SSA-3820-BK to collect information regarding a child applying for SSI disability payments. The information we collect on the SSA-3820-BK then provides the State Disability Determination Services (DDS) adjudicators a detailed explanation of a child’s medical history that is essential to the disability determination. SSA uses Form SSA-3820-BK to collect contact and biographic information about a child. It also includes details pertaining to the child’s condition including medical treating sources, medications being taken, medical tests, educational background, and work history if relevant. The State (DDS) evaluators use the information from Form SSA-3820-BK, including its electronic versions, to request and develop medical and school evidence, and to assess the alleged disability. The information collected on the form, together with medical evidence and other sources of non-medical evidence, provides the evidentiary basis upon which SSA makes its initial disability evaluation. The respondents are the responsible adult(s) applying on behalf of the child, such as the parents, guardians, and other caretakers who petition SSI childhood disability for initial and reconsideration decisions.

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:
	90 FR 42294	08/29/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 58678	12/17/2025
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	353,236	710,288	-355,144	-1,908
Annual Time Burden (Hours)	1,281,471	627,421	-5,919	659,969
Annual Cost Burden (Dollars)	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: When we last cleared this IC in 2022, the burden was 621,502 hours. We are currently reporting a burden of 706,087 hours. Although there is no change to the burden time per response, this change stems from a decrease in the number of paper Form SSA-3820 submissions that generally take less time to complete, and an increase in the number of electronic (ECDS and i3820) submissions, which take longer to complete. Although the number of responses decreased from 355,144 to 353,236, SSA did not take any action to cause this change, as this figure represents normal fluctuation in respondents for this information collection. These figures represent current management information data. SSA is only able to provide the total number of paper and electronic Form SSA 3820 and i3820 responses completed. SSA is unable to fully break down the method in which the SSI application is finalized or completed and submitted into the electronic disability case file necessary for adjudication, as we do not track that information. There is a possibility that a respondent physically takes a paper SSA-3820 to the FO, finalizes the i3820 process at the FO, or schedules an in person appointment at the FO for the technician to input data into the EDCS. This information collection is only able to predict how many respondents physically traveled to the FO. SSA predicts that 50% of respondents travel to the FO to complete the SSA-3820 and/or its finalization process verses the remaining 50% who may utilize teleservice methods. We are working on ways to obtain more precise data to make this estimate. SSA systems and operations provided additional data and reference points for SSA employee information collection and processing time and systems development, updating and maintenance. While the total annual cost to the federal government is significantly higher when compared to the last information collection in 2022, the current information collection reflects more accurate and relevant data related to the SSA-3820-BK and i3820 forms. * Note: The total burden reflected in ROCIS is X, while the burden cited in #12 of the Supporting Statement is 706,087. This discrepancy is because the ROCIS burden reflects the following components: field office and telephone wait 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: $2,328,721

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