Supplemental Justification for Revised Collection Instrument HA-1151

Supplemental Justification for Revised Collection Instrument HA-1151

0960-0662

Re: Medical Source Statement of Ability To Do Work-Related Activities

(Physical) -- HA-1151

Per our correspondent of August 8, 2006 attached is the corrected edition of the HA-1151, (entitled HA-1151 1-2006) and the previously submitted form for comparison (entitled HA-1151 09-05 EDITION). Outline below are the revisions between the originally submitted HA-1151 and the final version of the form dated 06/2006:

 

• Page 1, last paragraph under the defined terms, added “Age and body habits of the individual should not be considered in the assessment of limitations.  Added the word “clinical” after  “particular medical” in second sentence.

• Page 1, under lifting and carrying, added “Up” to B.; changed “21” to “20 in C.; changed “51” to “50 in D.

• Page 2, added section on use of a cane (the addendum in the OMB package discusses this section)

• Page 7, added “or clinical findings” in paragraph after chart and in item IX last line.

• Added to the paragraph at the bottom of each of the sections the language: “and why the findings support the assessment.”

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Correspondent Background

From: Hartson, Craig
Sent: Tuesday, August 08, 2006 10:44 AM
To: Lebowitz, Naomi
Cc: Lipsky, Faye; Davidson, Liz
Subject: FW: HA-1151

Naomi,

I just talked with Rachel and she said it’s okay to do the change sheet to implement the changes on the HA-1151. 

Craig Hartson 410-966-3268
Social Security Administration
Center for Publications Management
Reports Clearance Team
[email protected]

From: Hartson, Craig
Sent: Monday, August 07, 2006 1:25 PM
To: 'Potter, Rachel F.'
Subject: RE: HA-1151

Hi Rachel,

Did a double check with Naomi and we received no package requests or comments from the public during either notice period.

Craig Hartson 410-966-3268
Social Security Administration
Center for Publications Management
Reports Clearance Team
[email protected]

From: Potter, Rachel F. [mailto:[email protected]]
Sent: Friday, August 04, 2006 5:38 PM
To: Hartson, Craig
Cc: Lebowitz, Naomi; Davidson, Liz
Subject: RE: HA-1151

Did any members of the public request copies of the package during either the 60 day or 30 day review?  If so, did the copies they received contain the correct version of this form?  Did SSA receive any comments during either comment period?  Thanks.

From: Hartson, Craig [mailto:[email protected]]
Sent: Friday, August 04, 2006 9:37 AM
To: Potter, Rachel F.
Cc: Lebowitz, Naomi; Davidson, Liz
Subject: FW: HA-1151
Importance: High

Hi Rachel,

I’m doing follow-up for Liz on this one.  Have you had a chance to review the below requested action?  This collection was approved back in April, but the most recent version of the form was mistakenly not included in the package.  Attached are both forms for comparison and below an explanation of the revisions.  I don’t believe these represent significant changes; mainly “updated clarifying language” and we will follow-up with a change sheet.  Also I know the component is anxious to move forward with this so if you could get back to me sometime today I would appreciate it.  Give me a call with any questions.

THANKS!

Craig Hartson 410-966-3268
Social Security Administration
Center for Publications Management
Reports Clearance Team
[email protected]

From: Davidson, Liz
Sent: Tuesday, August 01, 2006 10:35 AM
To: 'Potter, Rachel F.'
Cc: Lebowitz, Naomi
Subject:
Importance: High

 

Rachel,

 

The first attachment is the form we believe was included in the OMB clearance request.  The second attachment is the form we intended to clear.  Below is a comparison of the forms.

 

• Page 1, last paragraph under the defined terms, added “Age and body habitus of the individual should not be considered in the assessment of limitations.  Added the word “clinical” after  “particular medical” in second sentence.

• Page 1, under lifting and carrying, added “Up” to B.; changed “21” to “20 in C.; changed “51” to “50 in D.

• Page 2, added section on use of a cane (the addendum in the OMB package discusses this section)

• Page 7, added “or clinical findings” in paragraph after chart and in item IX last line.

• Added to the paragraph at the bottom of each of the sections the language: “and why the findings support the assessment.”

 

We will prepare a change sheet after your review.  Thanks.

Liz Davidson
SSA Reports Clearance Officer
DCFAM, OPLM, OPUM
410-965-0454
Pager:  410-909-8175
Fax:  410-965-6400

 

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