Internet Social Security Disability Report (ISSDR)

ICR 200303-0960-006

OMB: 0960-0650

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
9690
Migrated
ICR Details
0960-0650 200303-0960-006
Historical Active 200205-0960-004
SSA
Internet Social Security Disability Report (ISSDR)
Extension without change of a currently approved collection   No
Regular
Approved without change 05/16/2003
Retrieve Notice of Action (NOA) 03/17/2003
Approved for use through 5/2006 under the following conditions: 1) no later than 9/2003, SSA briefs OMB on system architecture and security issues related to integration of the ISBA and ISSDR; and 2) for the public record, SSA submits to OMB the revised help screens that assist individuals in completing the medical history section of the ISSDR.
  Inventory as of this Action Requested Previously Approved
05/31/2006 05/31/2006 05/31/2003
66,000 0 66,000
132,000 0 132,000
0 0 0

The ISSD Report will collect allegations of disability and gather information about the disabling condition and sources of medical evidence. Collecting this information is critical to case development ad adjudication. The information on the Disability Report, together with other evidence and information, will be used by State Disability Determination Services to develop medical evidence, assess the alleged disability, and make a determination on whether or not the applicant is disabled under the Act.

None
None


No

1
IC Title Form No. Form Name
Internet Social Security Disability Report (ISSDR)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 66,000 66,000 0 0 0 0
Annual Time Burden (Hours) 132,000 132,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/17/2003


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