View Information Collection Request (ICR) Package

View ICR - Agency Submission

OMB Control No: 0960-0720	ICR Reference No: 202606-0960-002
Status: Received in OIRA	Previous ICR Reference No: 202010-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Certification of Low Birth Weight for SSI Eligibility
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 06/26/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	3,860	28,125
Time Burden (Hours)	1,287	7,031
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	3,860	28,125	-24,265
Annual Time Burden (Hours)	1,287	7,031	-5,744
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 cleared this ICR in 2023, the burden was 7,031 hours. However, we are currently reporting a burden of 955 hours. The decrease in burden is due to a decrease in the number of respondents from 28,125 to 3,860. We believe this was an inadvertent overstatement of burden hours in the previous clearance, as we did not have accurate Management Information (MI) data at that time. Thes revised figures represent current, more accurate MI data. 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. *Note: The total burden reflected in ROCIS is 1,287 while the burden cited in #12 of the Supporting Statement is 965. This discrepancy is because the ROCIS burden also reflects the learning costs.

Annual Cost to Federal Government: $24,814

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

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.