Medical Source Statement of Ability to Do Work-Related Activities

ICR 202404-0960-013

OMB: 0960-0662

Federal Form Document

ICR Details
0960-0662 202404-0960-013
Received in OIRA 202101-0960-006
SSA
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
  
None

Not associated with rulemaking

  89 FR 30428 04/23/2024
89 FR 55666 07/05/2024
No

  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 300,000 300,000 0 0 0 0
Annual Time Burden (Hours) 75,000 75,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$336,387
No
    Yes
    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.
07/05/2024


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