Evidence From Excluded Medical Sources of Evidence

ICR 201904-0960-013

OMB: 0960-0803

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2019-08-13
Supporting Statement A
2020-09-29
IC Document Collections
IC ID
Document
Title
Status
222015 Modified
ICR Details
0960-0803 201904-0960-013
Active 201805-0960-002
SSA
Evidence From Excluded Medical Sources of Evidence
Revision of a currently approved collection   No
Regular
Approved with change 09/29/2020
Retrieve Notice of Action (NOA) 08/16/2019
Agency made minor clarifications regarding the operation of this information collection and its burden estimation.
  Inventory as of this Action Requested Previously Approved
09/30/2023 36 Months From Approved 09/30/2020
3,000 0 3,000
1,000 0 1,000
0 0 0

Section 812 of the Bipartisan Budget Act of 2015 (BBA 812) amends section 223(d)(5) of the Social Security Act (Act) by adding a subsection “C.” BBA 812 mandates that the Social Security Administration (SSA) implement the provisions of amended section 223(d)(5)(C)(i) by regulation by November 2, 2016. Section 223(d)(5)(C)(i) of the Act, as amended, requires SSA to exclude evidence (except for good cause) from medical sources: (1) convicted of a felony under sections 208 or 1632 of the Act; (2) excluded from participating in any Federal health care program under section 1128 of the Act; or (3) imposed with a civil monetary penalty (CMP), assessment, or both, for submitting false evidence, under section 1129 of the Act. These final, new regulations will require excluded medical sources to self-report their excluded status in writing each time they submit evidence related to a claim for benefits under Titles II or XVI of the Act. Excluded medical sources’ duty to self-report their excluded status will apply to evidence they submitted to SSA directly or through a representative, claimant, or other individual or entity. The self-report will include: (1) the heading "WRITTEN STATEMENT REGARDING SECTION 233(d)(5)(C) OF THE SOCIAL SECURITY ACT - DO NOT REMOVE[,]" (2) the name and title of the affected source; and (3) the applicable excluding event (i.e., felony conviction, section 1128 exclusion, or CMP or assessment under section 1129). Felons must also include their date of conviction, and those imposed with a CMP must provide the dates of imposition. Sources excluded under section 1128 must include: (1) the basis of their exclusion; (2) its effective date and anticipated length, and (3) whether the Department of Health and Human Services' Office of Inspector General waived it. The respondents for this collection are medical sources that (1) meet one of the exclusionary categories set forth in section 223(d)(5)(C)(i) of the Act, as amended, and (2) furnish evidence related to a claim for benefits under Titles II or XVI of the Act.

US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
   PL: Pub.L. 114 - 74 812 Name of Law: Bipartisan Budget Act of 2015
   US Code: 42 USC 902 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  
PL: Pub.L. 114 - 74 812 Name of Law: Bipartisan Budget Act of 2015

Not associated with rulemaking

  84 FR 25891 06/04/2019
84 FR 40121 08/13/2019
No

1
IC Title Form No. Form Name
20 CFR 404.1503b(c) & 416.903b(c)

  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 3,000 3,000 0 0 0 0
Annual Time Burden (Hours) 1,000 1,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$47,679
No
    No
    Yes
No
No
No
No
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  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.
08/16/2019


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