State Agency Report of Obligations for SSA Disability Programs and Addendum; Time Report of Personnel Services for Disability Determination Services & State Agency Schedule of Equipment.....

ICR 200105-0960-003

OMB: 0960-0421

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0960-0421 200105-0960-003
Historical Active 200009-0960-005
SSA
State Agency Report of Obligations for SSA Disability Programs and Addendum; Time Report of Personnel Services for Disability Determination Services & State Agency Schedule of Equipment.....
Revision of a currently approved collection   No
Regular
Approved without change 06/11/2001
Retrieve Notice of Action (NOA) 05/04/2001
  Inventory as of this Action Requested Previously Approved
06/30/2004 06/30/2004 10/31/2003
648 0 216
756 0 216
0 0 0

Form SSA-4513 and 4514 are used to conduct detailed analysis and evaluation of the costs incurred by the State DDS in making disability determinations for SSA. The data is also used to determine funding levels for each DDS. SSA uses the information collected on form SSA-871 to budget and account for expenditures of funds for equipment purchases by the State DDS that administer the disability determination program. The respondents are DDSs that have the responsibility for making disability determinations for SSA.

None
None


No

  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 648 216 0 0 432 0
Annual Time Burden (Hours) 756 216 0 0 540 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
05/04/2001


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