Medical Source Statement of
Ability to Do Work-Related Activities
Revision of a currently approved collection
No
Regular
07/05/2024
Requested
Previously Approved
36 Months From Approved
07/31/2024
300,000
300,000
75,000
75,000
0
0
When a claimant appeals a denied
disability claim, SSA may ask the claimant to have a consultative
examination at the agency’s expense, if the claimant’s medical
sources cannot, or will not, give the agency sufficient evidence to
determine whether the claimant is disabled. The medical providers
who perform these consultative examinations provide a statement
about the claimant’s state of disability. Specifically, these
medical source statements determine the work-related capabilities
of these claimants. SSA collects the medical data on the HA-1151
and HA-1152 to assess the work-related physical and mental
capabilities of claimants who appeal SSA’s previous determination
on their issue of disability. The respondents are medical sources
who provide reports based either on existing medical evidence or on
consultative examinations.
US Code:
42
USC 1381 Name of Law: Social Security Act
US Code: 42
USC 902 Name of Law: Social Security Act
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.