Supporting Statement 0677(revised)

Supporting Statement for the

Medical Consultant’s Review of Psychiatric Review Technique Form

Form Number SSA-3023

OMB No. 0960-0677

A. Justification

1. Introduction/Authoring Laws and Regulations

In accordance with 20 CFR 404.1640, 404.1643 and 404.1645 of the Code of Federal Regulations, the Social Security Administration (SSA) measures the performance of Disability Determination Services (DDSs) in the area of quality of documentation and determinations on claims. Section 221(c) of the Social Security Act requires that SSA review state agency performance in individual cases and classes of cases. Standards help assure effective and uniform administration of SSA’s disability program. In accordance with 20 CFR 404.1520a and 416.920a, DDS’s administering the Title II (Disability Insurance) and Title XVI (Supplemental Security Income) programs are required to evaluate the severity of mental impairments using form SSA-2506-BK, Psychiatric Review Technique (OMB No. 0960-0413). Section 1633(a) of the Social Security Act provides that the Commissioner of Social Security may make arrangements as appropriate to carry out any administrative functions as necessary. This clearance request is for a renewal of the SSA-3023, Medical Consultant’s Review of the Psychiatric Review Technique Form, described in item 2.

2. Description of Collection

Form SSA-3023 is a program evaluation form that SSA’s regional review component uses to facilitate the contract medical/psychological consultant’s review of the Psychiatric Review Technique Form (PRTF). The medical/psychological consultant only completes form SSA-3023 when an adjudicating component’s PRT is in the file. Form SSA-203 is required for each PRT form completed.

After the medical/psychological consultant fills out the SSA-3023 in SSA’s Electronic Disability Collect System (EDCS) and submits the information, the consultant files it in the electronic folder for the claimant whose case the medical/psychological consultant is working on.

Electronic claim folders (eView) are stored on SSA’s intranet. If the medical/psychological consultant fills out the paper form manually, he/she scans it into eView. This collection is mandatory in order to obtain benefits. The medical/psychological consultant’s can collect the information through the intranet or use a paper form. The respondents are medical/psychological consultants who review the PRTF for quality purposes.

2. Use of Information Technology to Collect the Information

In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Intranet version of Form SSA-3023. The medical/psychological consultant can submit the information electronically through the Accelerated Electronic Disability Insurance Benefits (AeDib) process, or on paper version. Based on our data, we estimate approximately 95% of respondents under this OMB number use the electronic version, and 5% will use paper form.

2. Why We Cannot Use Duplicate Information

The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to obtain similar data.

2. Minimizing Burden on Small Respondents

This collection does not affect small businesses or other small entities

2. Consequence of Not Collecting Information or Collecting it Less Frequently

If we did not use form SSA-3023, the reviewing medical/psychological consultants would have an increased burden of recording the review in free form narrative. Consequently, Categories of Disorders, Ratings of Functional Limitations, various listings and Medical Disposition agreements/disagreements would have to be by the medical/psychological consultants in long hand, as opposed to using a check sheet. Collection of this information is mandatory, and, because we only collect the information once, we cannot collect it less frequently.

Generally, the medical/psychological consultant completes the form only once. However, on occasion, there may be more than one Psychiatric Review Technique form in file. In that case, the medical/psychosocial consultant must fill out form SSA-3023 for each Psychiatric Review Technique form. There are no technical or legal obstacles to burden reduction.

2. Special Circumstances

There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.

8. Solicitation of Public Comment and Other Consultations with the Public

SSA published the 60-day advance Federal Register Notice on September 2, 2009 at 74 FR 45508, and we received no public comments. SSA published the second Notice was published on November 17, 2009, at 74 FR 59336. We did not consult with the public in the revision/maintenance of this form.

8. Payment or Gifts to Respondents

SSA does not provide payments or gifts to the respondents.

8. Assurances of Confidentiality

SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.

8. Justification for Sensitive Questions

The information collection does not contain any questions of a sensitive nature.

8. Estimates of Public Reporting Burden

Approximately 344 medical/psychological consultants take 12 minutes each to complete form SSA-3023 each year. Accordingly, the burden is 11,352 hours. The medical/psychological consultants can either complete form SSA-3023 internally on SSA’s intranet, or on paper form, both processes take 12 minutes.

8. Annual Cost to the Respondents (Other)

This collection does not impose a known cost burden to the respondents.

8. Annual Cost To Federal Government

The annual cost to the Federal Government is approximately $1,029,614.00. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.

8. Program Changes or Adjustments to the Information Collection Request

There has been a decrease in burden hours based on 2008 statistical. This data is based the recalculation of incidence of quality review of mental disability claims.

16. Plans for Publication Information Collection Results SSA will not publish the results of the information collection.

17. Displaying the OMB Approval Expiration Date For paper form SSA-3023, we will not publish the OMB approval expiration date. OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.

For the Intranet version of form SSA-3023, SSA is not requesting an exception to the requirement to display the OMB approval expiration date.

18. Exceptions to Certification Statement

SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

B. Collection of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.