Medical Consultant's Review of Psychiatric Review Technique Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-3023 Medical Consultant's Review of Psychiatric Review Technique Form	Form and Instruction	Modified	Available
PA addendum.doc	Supporting Statement B	Uploaded 2009-10-23	Available
Supporting Statement 0677(revised).doc	Supporting Statement A	Uploaded 2009-12-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9731	Medical Consultant's Review of Psychiatric Review Technique Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0677	ICR Reference No: 200907-0960-012
Status: Historical Active	Previous ICR Reference No: 200612-0960-017
Agency/Subagency: SSA	Agency Tracking No:
Title: Medical Consultant's Review of Psychiatric Review Technique Form
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: 02/24/2010
	Date Received in OIRA: 12/02/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2013	36 Months From Approved	02/28/2010
Responses	56,760	0	66,736
Time Burden (Hours)	11,352	0	13,347
Cost Burden (Dollars)	0	0	0

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Abstract: SSA measures the performance of the State Disability Determination Services (DDSs) in the area of quality of documentation and determinations on claims. In mental disability claims, a Psychiatric Review Technique Form (PRTF) is completed by DDS. The SSA-3023 is only completed when an adjudicating component's PRTF is in the file; an SSA-3023 is required for each completed PRTF. Form SSA-3023 is used by the regional review component to facilitate SSA's medical/psychological consultants' review of the PRTF for quality purposes. The respondents are medical/psychological consultants who review the Psychiatric Review Technique Form for quality purposes.

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Authorizing Statute(s): US Code: 42 USC 421 Name of Law: Social Security Act
   US Code: 42 USC 1383b Name of Law: Social Security Act
  

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:
	74 FR 45508	09/02/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 59336	11/17/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Medical Consultant's Review of Psychiatric Review Technique Form	SSA-3023, SSA-3020 (AeDib Form)	Medical Consultant's Review of Psychiatric Review Technique Form ,   Medical Consultant's Review of Psychiatric Review Technique Form

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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	56,760	66,736	0	0	-9,976	0
Annual Time Burden (Hours)	11,352	13,347	0	0	-1,995	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 has been a decrease in burden hours due to recalculating the incidence of quality review of mental disability claims based on current 2008 fiscal year statistical data.

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Annual Cost to Federal Government: $1,029,614

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)? No

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: 12/02/2009

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