Request for Accommodation in Communication Method

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-9000 Request for Accommodation in Communication Method (paper form)	Form and Instruction	New	Repair queued
0960-NEW SSA-9000 Emergency Clearance Letter 2-22-10.pdf	Supplementary Document	Uploaded 2010-02-22	Available
Supporting Statement 0960-NEW (SSA-9000).doc	Supporting Statement A	Uploaded 2010-02-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192018	Request for Accommodation in Communication Method (Intranet screens/field office interview)	Other-Intranet (internal SSA) screens	New
192017	Request for Accommodation in Communication Method (paper form)	Form and Instruction	New

ICR Details

OMB Control No: 0960-0777	ICR Reference No: 201002-0960-016
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Accommodation in Communication Method
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 03/01/2010
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/01/2010
	Date Received in OIRA: 02/22/2010
Terms of Clearance: Because of the district court order, OMB is approving this emergency request. However, if this or any similar information collection will be used beyond the 6-month window provided in the clearance, or for any purpose not required by the court order, SSA must seek regular, non-emergency approval and provide OMB with a full opportunity for review.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2010	6 Months From Approved
Responses	2,500	0	0
Time Burden (Hours)	458	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In a recent legal action, American Council of the Blind, et al v. Michael Astrue and Social Security Administration (No. C 05-04696 WHA (N.D. Cal.), the district court ordered SSA to offer two additional modalities(besides the three already available) for sending notices and other communications to blind or visually impaired applicants, beneficiaries, recipients, and representative payees. If members of these groups want to request another communication method besides the five ordered by the court, the will complete new form SSA-9000, the Request for Accommodation in Communication Method. The SSA-9000 will ask respondents to describe the type of accommodation they want, to disclose the condition they have that necessitates the need for a different type of accommodation, and to explain why none of the five methods already offered by the agency is sufficient.

Emergency Justfication: In accordance with the district court’s order (American Council of the Blind, et al v. Michael Astrue and Social Security Administration (No. C 05-04696 WHA (N.D. Cal.)), SSA must begin processing 45 C.F.R. 85.51 accommodation requests on April 15, 2010. Therefore, SSA is requesting emergency clearance under 5 CFR 1320.13. See Emergency Clearance Letter for further explanation in Supplementary Documents.

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Authorizing Statute(s): US Code: 29 USC 794 Name of Law: Section 504 of the Rehabilitation 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:
	75 FR 7648	02/22/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Request for Accommodation in Communication Method (paper form)	SSA-9000	Request for Accommodation in Communication Method
Request for Accommodation in Communication Method (Intranet screens/field office interview)

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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	2,500	0	0	2,500	0	0
Annual Time Burden (Hours)	458	0	0	458	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This collection instrument will allow SSA to better serve the needs of the blind or visually impaired public. Under 45 CFR 85.51, SSA must “take appropriate steps to ensure effective communication with applicants, participants, personnel of other Federal entities, and members of the public.” Further, the regulation states that SSA must “furnish appropriate auxiliary aids where necessary to afford an individual with handicaps an equal opportunity to participate in, and enjoy the benefits of, program or activity conducted by the agency.” 45 CFR 85.51 (a)(1). The Court Order compels SSA to begin processing 45 CFR 85.51 accommodation requests on April 15, 2010 for blind or visually impaired Social Security recipients.

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Annual Cost to Federal Government: $187,533

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: 02/22/2010

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