Disability Report - Child

Forms and Documents

Document Name	Status
Form SSA-3820-BK Disability Report - Child (Paper) Form and Instruction	Modified
ADDENDUM 0577.doc Supplementary Document	2013-07-22
Supporting Statement 0577 (revised).doc Supporting Statement A	2013-09-12

IC Document Collections

IC ID	Document Title	Status
9538	Disability Report - Child (Paper) Form and Instruction	Modified
179519	Disability Report - Child (Internet) Other-Disability Report - Child (Internet)	Modified
179518	Disability Report - Child (EDCS) Other-EDCS	Modified

ICR Details

OMB Control No: 0960-0577	ICR Reference No: 201304-0960-010
Status: Historical Active	Previous ICR Reference No: 201009-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Report - Child
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/26/2013
	Date Received in OIRA: 09/13/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	36 Months From Approved	11/30/2013
Responses	541,500	0	515,793
Time Burden (Hours)	542,750	0	426,219
Cost Burden (Dollars)	0	0	0

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Abstract: hen claimants file a claim for childhood disability benefits under the SSI program, they must furnish medical and other evidence to prove they are disabled. Form SSA–3820 collects various types of information about a child’s condition from treating sources and/or other medical sources of evidence. The DDS evaluators use the information to develop medical and school evidence and to assess the alleged disability. The information, together with medical evidence, forms the evidentiary basis upon which SSA makes its initial disability evaluation. The respondents are claimants seeking SSI childhood disability payments.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 423 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 39054	06/28/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 56265	09/12/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Disability Report - Child (Paper)	SSA-3820-BK	Disability Report - Child
Disability Report - Child (Internet)
Disability Report - Child (EDCS)

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ICR Summary of Burden

	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	541,500	515,793	0	446,707	-421,000	0
Annual Time Burden (Hours)	542,750	426,219	0	353,414	-236,883	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There has been an increase in burden hours. The increase stems from an increase in the users completing the Internet version of Form SSA-3820 (i3820).

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Annual Cost to Federal Government: $163,750

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/13/2013

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