Disability Report - Adult, 20 CFR 404.1512 and 416.912

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-3368 Disability Report - Adult, 20 CFR 404.1512 and 416.912 (Paper)	Form and Instruction	Modified	Available
SSA3820 Supporting Statement 021507.doc	Supporting Statement A	Uploaded 2007-07-12	Available
3368 Addendum.doc	Supplementary Document	Uploaded 2007-07-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9548	Disability Report - Adult, 20 CFR 404.1512 and 416.912 (Paper)	Form and Instruction	Modified
179421	Disability Report - Adult, 20 CFR 404.1512 and 416.912 (PRO)	Other-i3368 PRO	New
179420	Disability Report - Adult, 20 CFR 404.1512 and 416.912(Internet)	Other-SSA-3368 (Internet)	New
179419	Disability Report - Adult, 20 CFR 404.1512 and 416.912 (EDCS)	Other-EDCS	New

ICR Details

OMB Control No: 0960-0579	ICR Reference No: 200704-0960-003
Status: Historical Inactive	Previous ICR Reference No: 200608-0960-012
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Report - Adult, 20 CFR 404.1512 and 416.912
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 08/02/2007
	Date Received in OIRA: 07/24/2007
Terms of Clearance: This ICR is returned because the wrong supporting materials were submitted. SSA should resubmit this ICR with the correct materials.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2008	36 Months From Approved	01/31/2008
Responses	2,116,667	0	2,116,667
Time Burden (Hours)	2,257,667	0	2,257,667
Cost Burden (Dollars)	0	0	0

---

Abstract: The Disability Report-Adult collects medical and other evidence which is used to determine whether an adult's impairment is disabling, and consequently, if that adult is entitled to Title II and/or Title XVI disability payments from the Social Security Administration. The information can be collected through the following ways: a paper form, in an SSA field office, an Internet version, and a new Internet version designed to be completed by professional advocacy groups. The respondents are adult disability applicants or their representatives.

---

Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: null
   US Code: 42 USC 423 Name of Law: null
   US Code: 42 USC 405 Name of Law: null
  

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:
	72 FR 20154	04/23/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 32697	06/13/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Disability Report - Adult, 20 CFR 404.1512 and 416.912(Internet)
Disability Report - Adult, 20 CFR 404.1512 and 416.912 (Paper)	SSA-3368	Disability Report - Adult, 20 CFR 404.1512 and 416.912
Disability Report - Adult, 20 CFR 404.1512 and 416.912 (PRO)
Disability Report - Adult, 20 CFR 404.1512 and 416.912 (EDCS)

---

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is not a decrease in burden, when we separated the IC's the system is showing it as a decrease. There is actually a 1,337,156 hour increase in the public reporting burden (from 2,215,617 hours to 3,552,823 hours) since the last Supporting Statement was submitted to OMB. The change is due to several factors. A major factor is that we have been able to compile more accurate data since we prepared the previous Supporting Statement. Other factors are increased use of the EDCS 3368, i3368 and i3368-PRO, and the additional time it takes respondents to use the i3368 and i3368-PRO over the time it takes for use of the EDCS 3368 and paper SSA-3368.

---

Annual Cost to Federal Government: $34,708,811

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: 07/24/2007

---