Privacy and Disclosure of Official Records and Information; Availability of Information and Records to the Public

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-3288 Consent of Release of Records	Form and Instruction	New	Available
Supporting Statement--0566(R).doc	Supporting Statement A	Uploaded 2006-09-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45123	Waiver/Reduction of Fees		New
45122	FOIA Requests for Records		New
45121	Consent of Release of Records	Form and Instruction	New
45120	Amendment of Records		New
45119	Designating a Representative For Disclosure		New
38034	Access to Records		Modified

ICR Details

OMB Control No: 0960-0566	ICR Reference No: 200609-0960-004
Status: Historical Active	Previous ICR Reference No: 200603-0960-015
Agency/Subagency: SSA	Agency Tracking No:
Title: Privacy and Disclosure of Official Records and Information; Availability of Information and Records to the Public
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/11/2006
	Date Received in OIRA: 09/18/2006
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2009	36 Months From Approved	12/31/2006
Responses	3,028,500	0	2,223,500
Time Burden (Hours)	159,133	0	111,175
Cost Burden (Dollars)	0	0	0

---

Abstract: This information is required to identify individuals who request access to their records; designate an individual to receive and review their medical records; correct or amend records; obtain consent from an individual to release his/her records to others (consent is submitted by letter in writing or by use of the SSA-3288, or other consent form); and to facilitate the release of the information under the Freedom of Information Act. Respondents are individuals or businesses requesting access to, correction of, or disclosure of SSA records.

---

Authorizing Statute(s): US Code: 5 USC 552 Name of Law: The Freedom of Information Act
   US Code: 5 USC 552a Name of Law: The Privacy Act of 1974
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 34181	06/13/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 53485	09/11/2006
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Amendment of Records
Waiver/Reduction of Fees
FOIA Requests for Records
Designating a Representative For Disclosure
Consent of Release of Records	SSA-3288	Consent for Release of Information
Access to Records

---

ICR Summary of Burden

table that charts list of burden

	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	3,028,500	2,223,500	0	0	805,000	0
Annual Time Burden (Hours)	159,133	111,175	0	0	47,958	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: The increase in the public reporting burden from 111,175 to 195,133 is due to an increase in third party consents for verification and release of information.

---

Annual Cost to Federal Government: $1,120,000

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

---

Common Form ICR:  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:

(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: 09/18/2006

---