The information collected by forms
SSA-4734-BK & SSA-4734-F4-SUP is used by SSA to assist in the
adjudication of disability claims involving physical and mental
impairments, respectively. The forms assist the State Disability
Determination Services (DDSs) in evaluating impairments by
providing a standardized information collection format so that
medical findings are presented in a clear, concise, and consistent
manner. The respondents are physicians employed by the State DDSs
to evaluate applicants for SSA benefits.
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.