Supporting Statement for Form SSA-824
20 CFR 404.1513 and 20 CFR 416.913
OMB No. 0960-0058
A. Justification
1. The Social Security Administration (SSA) collects this information to determine if a claimant or applicant filing for disability benefits has an impairment that meets the severity and duration requirements of the law. The statutory and regulatory authority for using this form are contained in Sections 223(d) and 1614(a) of the Social Security Act, and both 20 CFR 404.1513 and 20 CFR 416.913 of the Code of Federal Regulations.
2. The purpose of Form SSA-824 is to obtain medical evidence from medical sources that have treated the claimant for a mental impairment. SSA uses the information collected on this form to establish whether a claimant filing for disability benefits has a mental impairment that meets the statutory definition of disability in the Act. The respondents are mental treatment facilities.
3. To the extent that the respondent wishes to do so, responses to this information collection may be submitted by teledictation. However, most respondents prefer to complete Form SSA-824. Due to the Agency’s limited resources, an electronic version of form SSA-824 has not, yet, been developed, as the higher volume forms must be converted first. At this time, the Agency does not have a set date for electronic conversion of the SSA-824.
4. The nature of the information being collected and the manner in which it is collected preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.
5. This collection does not have a significant impact on a substantial number of small businesses or other small entities.
6. This information must be collected to comply with the law and regulations cited in Item 1 above. The cost of the disability programs would increase if the information were collected less frequently, because we would have to resort to other more costly methods, i.e., consultative examinations, to obtain the evidence necessary to evaluate disability claims involving mental impairments. There are no technical or legal obstacles that prevent burden reduction.
7. There are no special circumstances that would cause this information collection to be conducted in a manner that is not consistent with 5 CFR 1320.5.
8. The 60-day advance Federal Register Notice published on August 22, 2008, at 73 FR 49730. SSA received no public comments. The second Notice published on December 11, 2008, at 73 FR 75491. There have been no outside consultations with members of the public.
SSA pays non-Federal respondents for the reasonable cost of providing the information, as required by sections 223(d)(5)(A) and 1614(a)(3)(H)(i) of the Act and 20 CFR 404.1514 and 416.914. SSA does not provide any gifts to the respondents.
10. The information requested is protected and held confidential in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.
11. The information collected, by its nature, is sensitive because it relates to mental problems and disorders. However, because a disability determination cannot be made without collecting the information, it is essential that we make every reasonable effort to obtain it. If the respondent does not reply, we must look to other sources of evidence, including, when necessary, purchased consultative examinations.
12. The estimated total number of respondents is 50,000. We estimate that half are private sector and half State and Local government. However, we do not collect information about the number or type of individual respondents or how many responses are provided annually by each respondent, because we have no need for such information. Therefore, there is no justification for imposing such an additional reporting burden on the public, i.e., the State Disability Determination Services (DDSs) who collect the information and make disability determinations for SSA. The estimated response time, based on staff judgment and prior experience, is 36 minutes. Thus, the estimated burden for this information collection is 30,000 hours as shown on the chart below:
Type of Respondents |
Number of Respondents |
Frequency of Response |
Average Burden Per Response |
Total Annual Burden |
Private Sector |
25,000 |
1 |
36 |
15,000 |
State DDSs (State/Local Government) |
25,000 |
1 |
36 |
15,000 |
Totals |
50,000 |
|
|
30,000 |
SSA reflects the total burden as burden hours, and has not calculated a separate cost burden.
13. There is no known cost burden to the respondents.
14. The annual cost to the Federal Government is approximately $904,000. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information. This cost includes an average Medical Evidence of Record cost of $15 per respondent.
15. There are no changes in the public reporting burden. However, prior to ROCIS we were unable to create separate ICs for the types of respondents (Private Sector and State DDSs). We have created separate ICs within this ICR to show each of the types of respondents individually.
16. The results of the information collection will not be published.
17. OMB has granted SSA an exemption from the requirement that the expiration date for OMB approval be printed on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). OMB granted this exemption so that otherwise useable editions of forms would not be taken out of circulation because the expiration date had been reached. In addition, Government we avoid Government waste because we will not need to destroy and reprint stocks of forms.
18. SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
Statistical methods are not used for this information collection.
| File Type | application/msword |
| File Title | May 14, 1999 |
| Author | YCROSS |
| Last Modified By | Davidson, Liz |
| File Modified | 2009-01-12 |
| File Created | 2009-01-12 |