Addendum to the Supporting Statement for the SSA-91 (Final)

Addendum to the Supporting Statement for OMB Clearance for the SSA-91

Request to Release Medical Report to a Health Care Provider

20 CFR 401.55 & 401.100

0960-NEW

Revisions to the Collection Instrument

In order to maintain consistency, clarify language, and make this form more generic for use within the broader medical field, we are making the following revisions to the SSA‑91:

• The word "request" has been substituted for "authorization" to be consistent with the Privacy Act provision which allows individuals to request that records be provided to other parties. 

• We are revising language pertaining to the physician in order to make it more generic as the health care professional may be a doctor other than a physician (e.g., a psychologist, optometrist or SLP). Therefore, we are changing the term “physician” to “health care provider.”

• For the reasons listed above, we are changing the terms “personal physician” and “your doctor” to “health care provider.”

• We are also removing the Service Request Number from the form as it is no longer necessary.

• We are removing the words “Paperwork Reduction Act” from the top of page 2 as it is redundant (it appears again lower on the page where the PRA is actually placed).

• We made the following changes to the Privacy Act Notice shown on the SSA-91:

  • We have removed the CFR citations and replaced them with citations from the Social Security Act.

  • We have replaced the words “personal physician” and “your doctor” with “health care provider.”