Authorization to Disclose Information to the Social Security Administration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-827 Authorization To Disclose Information To The Social Security Administration	Form and Instruction	Modified	Available
Form SSA-827 Authorization to Disclose Information to the Social Security Administration	Form	Modified	Available
Addendum--0623.doc	Supplementary Document	Uploaded 2008-02-13	Available
Supporting Statement--0623.doc	Supporting Statement A	Uploaded 2008-02-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9639	Authorization to Disclose Information to the Social Security Administration / SSA-827	Form and Instruction	Modified	Authorization To Disclose Information To The Social Security Administration
183732	Authorization to Disclose Information to the Social Security Administration (Internet Instructions)	Instruction	New
179551	Authorization To Disclose Information To The Social Security Administration / SSA-827 (sign and date only)	Form	Modified	Authorization to Disclose Information to the Social Security Administration

ICR Details

OMB Control No: 0960-0623	ICR Reference No: 200712-0960-006
Status: Historical Active	Previous ICR Reference No: 200704-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Authorization to Disclose Information to the Social Security Administration
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/15/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/12/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved	06/30/2010
Responses	16,001,944	0	15,415,712
Time Burden (Hours)	864,329	0	835,017
Cost Burden (Dollars)	0	0	0

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Abstract: SSA must obtain sufficient medical evidence to make eligibility determinations for title II and title XVI payments. Therefore, the applicant must authorize their medical source(s) to release the information to SSA. The applicant may use form SSA-827 to provide consent for the release of information. Generally, the State DDS completes the form(s) based on information provided by the applicant, and sends the form(s) to the designated medical source(s).

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Authorizing Statute(s): US Code: 42 USC 405
   US Code: 42 USC 1383
   US Code: 42 USC 423
   US Code: 42 USC 1382c
  

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 62510	11/05/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 7782	02/11/2008
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
Authorization To Disclose Information To The Social Security Administration / SSA-827 (sign and date only)	SSA-827	Authorization to Disclose Information to the Social Security Administration
Authorization to Disclose Information to the Social Security Administration (Internet Instructions)
Authorization to Disclose Information to the Social Security Administration / SSA-827	SSA-827	Authorization To Disclose Information To The Social Security Administration

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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	16,001,944	15,415,712	0	0	586,232	0
Annual Time Burden (Hours)	864,329	835,017	0	0	29,312	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: The public reporting burden has been increased by 29,312 hours to account for the time it takes Internet users to read the form explanation screens.

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Annual Cost to Federal Government: $23,740,196

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: 03/12/2008

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