Justification for Non-Substantive Changes - 0577

Justification for Non-Substantive Changes for Form SSA-3820-BK and i3820

Disability Report - Child

20 CFR 416.924a

OMB No. 0960-0577

Background:

Form SSA-3820-BK, (Disability Report -Child), provides the Disability Determination Service adjudicators with a detailed explanation of a Title XVI disabled child’s medical history that is essential to the disability determination.

Under Section 7, the individual completing the form should record whether the child is receiving services from other Federal, State, or Local government agencies; include the name(s) and address(es) of each agency, phone number, type of test(s) conducted and date of test(s). This information can serve as valuable sources of medical and non-medical evidence.

The Social Security Administration (SSA) implemented processes to allow applicants to complete and submit the SSA-3820 online. This online application is the Internet Child Disability Report or i3820. The i3820 allows the Internet user (IU), a person who is filing on behalf of a child, to provide disability information about a child who is filing for disabled child benefits under the Supplemental Security Income (SSI) program. The IU, or applicant, identifies their relationship (e.g., parent, relative, neighbor, or attorney) to the child within the i3820 screens. The IU, or applicant, provides information about the child’s medical condition(s), medical records, education, and work history, if applicable.

Revisions to the SSA-3820

• Change #1: We are making the following revision to the language on page 10, Section 7A:

• Old Language: Mental Health/Mental Retardation Center

• New Language: Mental Health/Developmental Disabilities Center

Justification #1: We are revising the language due to a statutory change in terminology.

Revisions to the i3820:

• Change #2: We are revising language in the i3820 Internet application on the Medical History: Additional Sources of Testing or Examination screen:

• Old Language: Mental Health/Mental Retardation Center

• New Language: Mental Health/Developmental Disabilities Center

Justification #2: We are revising the language due to a statutory change in terminology.

• Change #3: We are revising language throughout the screen in the i3820 Internet application on the Medical History page:

  • Old Language: Mental Health/Mental Retardation Center

  • New Language: Mental Health/Developmental Disabilities Center

Justification #3: We are revising the language due to a statutory change in terminology.

• Change #4: We are revising language throughout the screen in the i3820 Internet application on the Summary Page under Add Another Program (Special Health Care):

• Old Language: Mental Health/Mental Retardation Center

• New Language: Mental Health/Developmental Disabilities Center

Justification #4: We are revising the language due to a statutory change in terminology.

SSA will implement the changes to the SSA-3820-BK and i3820 upon OMB approval. These revisions will not affect the current reporting burden for the SSA-3820-BK or the i3820 screens.