Vocational Rehabilitation Provider Claim

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-199 Vocaional Rehabilitation Provider Claim	Form	Modified	Available
SUPPORTING_STATEMENT-0616.doc	Supporting Statement A	Uploaded 2009-10-27	Available
AddendumFinal.doc	Supplementary Document	Uploaded 2009-08-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9208	Vocaional Rehabilitation Provider Claim	Form	Modified
45274	Preparing Causality Statements	Other-Causality Statements	Modified
45273	Certifying Adherence to Cost Containment Policies and Procedures	Other-Written Certification	Modified

ICR Details

OMB Control No: 0960-0310	ICR Reference No: 200908-0960-001
Status: Historical Active	Previous ICR Reference No: 200609-0960-021
Agency/Subagency: SSA	Agency Tracking No:
Title: Vocational Rehabilitation Provider Claim
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: 01/29/2010
	Date Received in OIRA: 10/29/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	36 Months From Approved	01/31/2010
Responses	13,080	0	13,080
Time Burden (Hours)	5,320	0	5,320
Cost Burden (Dollars)	0	0	0

---

Abstract: The Social Security Administration (SSA) refers certain disability beneficiaries to State Vocational Rehabilitation (VR) Agencies. The State VR agencies use the SSA-199 to make claims for reimbursement of the costs incurred from providing VR services for the beneficiaries. The information collected on the SSA-199 is used by SSA to determine whether or not, and how much, to pay the State VR Agencies under SSA's VR program. Respondents are State VR Agencies who offer Vocational and Employment services for SSA beneficiaries.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 422 Name of Law: null
   US Code: 42 USC 1382d Name of Law: null
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 41959	08/19/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 55080	10/26/2009
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Certifying Adherence to Cost Containment Policies and Procedures
Preparing Causality Statements
Vocaional Rehabilitation Provider Claim	SSA-199	Vocational Rehabilitation Provider Claim

---

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	13,080	13,080	0	0	0	0
Annual Time Burden (Hours)	5,320	5,320	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:

---

Annual Cost to Federal Government: $108,000

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

---

Common Form ICR:  No

---

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: 10/29/2009

---