Authorization to Source to Release Information to the Social Security Administration

ICR 200212-0960-005

OMB: 0960-0623

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0623 200212-0960-005
Historical Active 200007-0960-006
SSA
Authorization to Source to Release Information to the Social Security Administration
Revision of a currently approved collection   No
Regular
Approved without change 02/28/2003
Retrieve Notice of Action (NOA) 12/18/2002
Approved for use through 2/2004 under the condition that the next submission also includes the GPEA-compliant version of the SSA-827.
  Inventory as of this Action Requested Previously Approved
02/29/2004 02/29/2004 11/30/2003
15,415,712 0 15,415,712
2,569,285 0 770,876
0 0 0

SSA must obtain sufficient medical evidence to make eligibility determinations for title II and title XVI payments. Therefore, the applicant must authorize their medical source(s) to release the information to SSA. The applicant may use form SSA-827 to provide consent for the release of information. Generally, the State DDS completes the form(s) based on information provided by the applicant, and sends the form(s) to the designated medical source(s).

None
None


No

1
IC Title Form No. Form Name
Authorization to Source to Release Information to the Social Security Administration SSA-827

  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 15,415,712 15,415,712 0 0 0 0
Annual Time Burden (Hours) 2,569,285 770,876 0 1,798,409 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
12/18/2002


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