10-10-07 memo

From: Matsuoka, Karen Y.
Sent: Wednesday, October 10, 2007 6:42 PM
To: 'Davidson, Liz'
Cc: Lebowitz, Naomi
Subject: RE: Status of your Questions on the SSA-84, SSA-1696, SSA, 91
Liz, my responses are below. – Karen

From: Davidson, Liz [mailto:[email protected]]
Sent: Tuesday, October 09, 2007 10:14 AM
To: Matsuoka, Karen Y.
Cc: Lebowitz, Naomi
Subject: FW: Status of your Questions on the SSA-84, SSA-1696, SSA, 91

Karen,
Below is the information in response to our conference call.
Regarding the SSA-1696:
•

The checkbox was added to the SSA-1696 in order to eliminate the need for
the SSA-3288. Therefore, we will not be using the SSA-3288 in conjunction
with the SSA-1696 after OMB approves the addition of the checkbox.

This is fine (see earlier email).
Regarding the SSA-84 and SSA-91:
•

The SSA-3288 cannot be modified for parents/guardians signing the release
of medical information for children as such authorization is not allowed
under SSA regulations governing disclosures with consent: 20 CFR 401.100(b)
states “A parent or guardian of a minor is not authorized to give consent
to a disclosure of a minor’s medical record.”

If a parent/guardian is not authorized to give consent for disclosure of minors’ medical records, then how
is form SSA-91 legal? SSA-91 appears to be used by parents/guardians to give consent for disclosure of
minors’ medical records to the treating source.
Since form 91 is only going to be used for parents/guardians to release a minor’s medical report to the
treating source, why can’t SSA 3288 be used for that purpose? (i.e. in the “name/address” section, why
couldn’t the parent/guardian list the child’s treating source and “minor’s medical report” be listed as the
relevant information being released?)
•

•

However, a parent/guardian can gain access to the minor’s medical
record, if a request is made on behalf of the minor, by
designating a physician or other health professional as a
representative. The physician or health professional would be
obligated to turn all of the minor’s medical records to the
parent/guardian.
SSA does not currently have any form for requesting access
ƒ
to medical records of a minor or designating a health
professional representative. The SSA-91 would fill this
need.
While SSA could use the SSA-3288 for adult claimants and the SSA-91 for
child claimants, this is not the preferred method.

o

•

If we use both the SSA-3288 and the SSA-91 we are creating the
potential for unnecessary processing errors which would not exist
if we only use one form for all of the claimants which OMVE
processes. For this reason, SSA would prefer to use only the SSA91.
SSA has removed the Service Request Number from the SSA-91 (as we no
longer require it for processing), and has made some minor changes to both
the SSA-84 and the SSA-91. With the exception of the removal of the
Service Request Number, the revisions are non-substantial (see attached
revised addendums and revised forms).

The changes to SSA-91 are fine. But since this ICR contains only SSA-91, the revisions to SSA-84 will
have to be made separately.
Please let me know if we need any further information.

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