SSA Work Disability Functional Assessment Battery (WD-FAB) Data Collection

Forms and Documents

Document Name	Status
0960-NEW - Supporting Statement Part B - WD-FAB (final).docx Supporting Statement B	2021-08-11
0960-NEW - Supporting Statement Part A - WD-FAB (final).docx Supporting Statement A	2021-08-11

IC Document Collections

IC ID	Document Title	Status
247278	Survey 2 (non-respondents) Other-Web Nonresponders Follow-up Script	New
247277	Survey 2 (respondents) Other-VR Survey	New
247276	Survey 2 Competency Screener Other-Classification Questions	New
247275	Survey 1 (non-respondents) Other-Follow-up Script	New
247265	Survey 1 (respondents) Other-Survey 1 VR-12	New
245828	Survey 1 Competency Screening Other-Survey 1 and 2 Classification Questions	New

ICR Details

OMB Control No:	ICR Reference No: 202102-0960-005
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: SSA Work Disability Functional Assessment Battery (WD-FAB) Data Collection
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/11/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	15,700	0
Time Burden (Hours)	6,988	0
Cost Burden (Dollars)	0	0

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Abstract: The Work Disability Funtional Assessment Battery (WD-FAB ) is a self-reported assessment measuring whole person-functioning at the activity level for eight work-related functional domains: Basic Mobility, Upper Body Function, Fine Motor Function, Community Mobility, Communication and Cognition, Resilience and Sociability, Self- Regulation, and Mood and Emotion (Jette et. al., 2019). SSA, National Institute of Health, and Boston University (BU) worked in collaboration to develop the WD-FAB to provide complementary information on functional capacity of the beneficiary in SSA’s disability adjudication process (Marfeo et al, 2013a). The specific purpose of this project is to administer the WD-FAB to a sample of working-age SSDI and SSI program beneficiaries who are due for their CDR. The data collected will be used to assess the feasibility and value of incorporating the WD-FAB into SSA’s CDR process with the intent of improving the CDR process.

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Authorizing Statute(s): None

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:
	86 FR 22510	04/28/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 44123	08/11/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Survey 1 (non-respondents)
Survey 1 (respondents)
Survey 1 Competency Screening
Survey 2 (non-respondents)
Survey 2 (respondents)
Survey 2 Competency Screener

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ICR Summary of Burden

	Total Request	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	15,700	0	0	15,700	0	0
Annual Time Burden (Hours)	6,988	0	0	6,988	0	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new data collection that increases the public reporting burden. See the chart above for burden figures.

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Annual Cost to Federal Government: $1,491,259

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 08/11/2021

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