State Agency Report of Obligations for SSA Disability Programs and Addendum; Time Report of Personnel Services for Disability Determination Services; Schedule of Equipment Purchased for SSA

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-4513-SUP Supplement State Agency Report of Obligations for SSA Disability Programs	Form	Modified	Available
Form SSA-4513 State Agency Report of Obligations for SSA Disability Programs	Form	Modified	Available
Form SSA-871 State Agency Schedule of Equipment Purchased for SSA Disability Programs	Form	New	Available
Form SSA-4514 Time Report of Personnel Services for Disability Determination Services	Form	New	Available
Supporting Statment--0421.doc	Supporting Statement A	Uploaded 2007-06-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9273	State Agency Report of obligations for SSA Disability Programs--SSA-4513 & SSA-4513-SUP	Form	Modified	Supplement State Agency Report of Obligations for SSA Disability Programs
9273	State Agency Report of obligations for SSA Disability Programs--SSA-4513 & SSA-4513-SUP	Form	Modified	State Agency Report of Obligations for SSA Disability Programs
9273	State Agency Report of obligations for SSA Disability Programs--SSA-4513 & SSA-4513-SUP	Instruction	Modified
180190	State Agency Schedule of Equipment Purchased for SSA Disability Programs	Form	New	State Agency Schedule of Equipment Purchased for SSA Disability Programs
180190	State Agency Schedule of Equipment Purchased for SSA Disability Programs	Instruction	New
180189	Time Report of Personnel Services for Disability Determination Services--SSA-4514	Form	New	Time Report of Personnel Services for Disability Determination Services
180189	Time Report of Personnel Services for Disability Determination Services--SSA-4514	Instruction	New

ICR Details

OMB Control No: 0960-0421	ICR Reference No: 200705-0960-010
Status: Historical Active	Previous ICR Reference No: 200405-0960-012
Agency/Subagency: SSA	Agency Tracking No:
Title: State Agency Report of Obligations for SSA Disability Programs and Addendum; Time Report of Personnel Services for Disability Determination Services; Schedule of Equipment Purchased for SSA
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: 08/23/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/14/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	36 Months From Approved	08/31/2007
Responses	624	0	208
Time Burden (Hours)	728	0	728
Cost Burden (Dollars)	0	0	0

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Abstract: Forms SSA-4513, SSA-4514 and SSA-871 are used to collect data necessary for detailed analysis and evaluation of costs incurred by State Disability Determination Services in making determinations of disability for SSA. The data are also utilized in determining funding levels for each DDS. Respondents are State DDSs.

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Authorizing Statute(s): US Code: 42 USC 421
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 13851	03/23/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 32697	06/13/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
State Agency Report of obligations for SSA Disability Programs--SSA-4513 & SSA-4513-SUP	SSA-4513, SSA-4513-SUP	State Agency Report of Obligations for SSA Disability Programs ,   Supplement State Agency Report of Obligations for SSA Disability Programs
State Agency Schedule of Equipment Purchased for SSA Disability Programs	SSA-871	State Agency Schedule of Equipment Purchased for SSA Disability Programs
Time Report of Personnel Services for Disability Determination Services--SSA-4514	SSA-4514	Time Report of Personnel Services for Disability Determination Services

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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	624	208	0	0	416	0
Annual Time Burden (Hours)	728	728	0	0	0	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: There are no changes in the public reporting burden. The change in the number of responses is due to an error made during conversion to ROCIS: we have always requested that the State DDSs reply quarterly to all three forms within this ICR; therefore, the number of responses is and should always be: 52 (DDSs) x 4 (quarters per year) x 3 (forms) = 624. Also, the other changes to the burden data are due to conversion to ROCIS. Previously we were not able to show the exact burden per form. Now that we are, we have created two additional ICs to show the burden calculations per form. No burden data has changed since 2005.

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Annual Cost to Federal Government: $24,358

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

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Common Form ICR:  No

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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: 06/14/2007

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