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OMB Control No: 0960-0681	ICR Reference No: 202609-0960-004
Status: Received in OIRA	Previous ICR Reference No: 202104-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Function Report - Adult
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/28/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	1,812,929	1,734,635
Time Burden (Hours)	3,233,057	2,630,863
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,812,929	1,734,635	78,294
Annual Time Burden (Hours)	3,233,057	2,630,863	602,194
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 the this ICR in 2023, the burden was 1,763,546 hours. However, we are currently reporting a burden of 1,843,144 hours. The increase in burden is due to an increase in the number of responses from 1,734,635 to 1,812,929. These figures represent current Management Information data. *Note: The total burden reflected in ROCIS is 3,233,057, while the burden cited in #12 of the Supporting Statement is 1,843,144. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + telephone call system wait times + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 above reflects actual burden.

Annual Cost to Federal Government: $21,919,234

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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