Request for Accommodation in Communication Method

ICR 201906-0960-007

OMB: 0960-0777

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2019-09-20
Supporting Statement A
2019-09-20
IC Document Collections
ICR Details
0960-0777 201906-0960-007
Historical Active 201607-0960-009
SSA
Request for Accommodation in Communication Method
Revision of a currently approved collection   No
Regular
Approved without change 12/03/2019
Retrieve Notice of Action (NOA) 09/20/2019
  Inventory as of this Action Requested Previously Approved
12/31/2022 36 Months From Approved 12/31/2019
5,000 0 5,000
1,667 0 1,667
0 0 0

SSA supplies a designated telephone number allowing Social Security applicants, beneficiaries, recipients, and representative payees who are blind or visually-impaired to tell SSA which of the following seven methods of communication they want SSA to use when it sends them benefit notices and other related communications: (1) standard print notice by first class mail, (2) standard print mail with a follow-up telephone call, (3) certified mail, (4) Braille, (5) Microsoft Word file on data compact disk (CD), (6) large print (18-point font) or (7) audio CD. However, respondents who want to receive notices from SSA through a communication method other than the seven methods listed above use Form SSA-9000 to: (1) describe the type of accommodation they want, (2) disclose their condition necessitating the need for a different type of accommodation, and (3) explain why none of the seven methods described above are sufficient for their needs. SSA uses Form SSA-9000 to determine, based on applicable law and regulation, whether to grant an individual's request for an accommodation based on their blindness, other visual impairment, and as applicable, another disabling condition. SSA collects this information electronically through either an in-person interview or a telephone interview during which the SSA employee keys in the information on Intranet screens. The respondents are Social Security applicants, beneficiaries, recipients, and representative payees who are blind or visually impaired and who ask SSA to send notices and other communications in an alternative method besides the seven modalities we described above.

US Code: 29 USC 794 Name of Law: Section 504 of the Rehabilitation Act
  
None

Not associated with rulemaking

  84 FR 31972 07/03/2019
84 FR 48694 09/16/2019
No

1
IC Title Form No. Form Name
Request for Accommodation in Communication Method SSA-9000-F6 Request for Accommodation

  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 5,000 5,000 0 0 0 0
Annual Time Burden (Hours) 1,667 1,667 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$60,000
No
    Yes
    Yes
No
No
No
Uncollected
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.
09/20/2019


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