Collection of the information on Forms
SSA-4814-FS and SSA-4815-F6 is necessary for SSA to determine if an
individual with Human Immunodeficiency Virus (HIV) infection meets
the requirements for presumptive disability (PD) payments. The SSA
Field Office (FO) will mail the appropriate form to the claimant's
medical source for completion and return to the FO. The FO staff
will use the information on the form to determine if a PD is
warranted. The respondents are the medical sources of the
applicants for SSI disability payments.
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.