This ICR is approved on the understanding that SSA will, within the next 36 months and prior to renewal of this ICR, convene two focus groups of (a) disability adjudicators and (b) SSA claimants/benes. Anecdotal evidence suggests that claimants have difficulty with the parts of this form that ask them to break down their daily work activities by the hour (i.e. "in this job, how many total hours each day did you crouch, kneel, stoop," etc.). In turn, SSA adjudicators may need to follow-up with claimants to get the information they need because they could not obtain it through the form. The purpose of these focus groups will be to evaluate the utility of this question and to assess the extent to which utility could be improved. SSA agrees to ask adjudicators questions such as "how ofen is the information provided on this form incomplete, unreliable, or otherwise inadequate, requiring you to follow-up with the claimant to get the information required?" Questions to be asked of claimants include questions like "how easy or difficult do you find this question to answer?"
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
12/31/2010
36 Months From Approved
12/31/2007
449,500
0
871,000
449,500
0
871,000
0
0
0
The SSA-3369-BK is used to document an applicant's work history. The information is used by Disability Determination Services (DDS) to make a decision about the alleged disability. The respondents are applicants for disability benefits.
The change in the SSA-3369 public burden hours since the last OMB Notice of Action (2004 OMB Approval) is based on data estimates that fewer respondents are using the paper form and the availability of EDCS 3369 data. Data collection for the EDCS 3369 didnÂt begin until 2004. The SSA-3369 public reporting burden hours in Item #12 now includes the EDCS 3369 data. There have been no program changes and only minor revisions to this form since the last OMB approval on 06/10/04.
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.
Form SSA-3369-BK Work History Report
SupportingStatement_3369_Final[1].doc
ssa3369.pdf
Work History Report