DIRECT APPLICATION DATA ENTRY - SCREENS AND OUTPUT DOCUMENTS

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Forms and supporting documents for this ICR

Document	Type	Status	Availability

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Information collection document groups

IC ID	Collection	Type	Status	Form
115453	DIRECT APPLICATION DATA ENTRY - SCREENS AND OUTPUT DOCUMENTS		Migrated

ICR Details

OMB Control No:	ICR Reference No: 198503-0960-008
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: DIRECT APPLICATION DATA ENTRY - SCREENS AND OUTPUT DOCUMENTS
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Disapproved	Conclusion Date: 04/17/1985
	Date Received in OIRA: 03/13/1985
Terms of Clearance: UNDER THE TERMS OF OMB APPROVAL OF ANY OF ITS INFORMATION COLLECTIONS, SSA IS AUTHORIZED TO REORDER QUESTIONS ON FORMS IN ANY WAY IT CHOOSES. (ALSO, QUESTIONS APPROVED FOR USE ON A FORM MAY ALSO BE TRANSFORMED FO USE WITH TELEPHONE INTERVIEWS, AND VICE-VERSA, SO LONG AS SUCH A CHANG IS MADE WITHOUT INCREASING BURDEN ON THE PUBLIC BY INCREASING THE NUMB OF RESPONDENTS OR BY MODIFYING THE CONTENT OF ANY PARTICULAR QUESTION. OMB APPROVES USE OF PARTICULAR QUESTIONS, NOT OF PARTICULAR FORMATS. W ARE NOT APPROVING OF THIS SUBMISSION BECAUSE SSA DID NOT PROVIDE SUFFICIENT INFORMATION AS TO WHETHER QUESTIONS IDENTICAL TO THOSE THAT HAVE ALREADY RECIEVED OMB CLEARANCE ARE BEING USED. TO REVIEW THIS PACKAGE BY COMPARING THE REFORMATTED QUESTIONS TO THOSE PRESENTLY APPROVED WOULD REQUIRE EXCESSIVE STAFF RESOURCES.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THE INFORMATION COLLECTED BY THE USE OF THE FOSE-DADE SYSTEMS GENERATE CLAIMS APPLICATIONS IS NEEDED TO DETERMINE A CLAIMANT'S ENTITLEMENT TO SOCIAL SECURITY RETIREMENT, SURVIVORS, DISABILITY OR HEALTH INSURANCE BENEFITS. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS W WISH TO FILE AN APPLICATION FOR SOCIAL SECURITY BENEFITS.

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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:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
DIRECT APPLICATION DATA ENTRY - SCREENS AND OUTPUT DOCUMENTS

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 03/13/1985

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