Disability Report - Child

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-3820-BK Disability Report - Child (Paper)	Form and Instruction	Unchanged	Available
Justification_for_Non-Substantive_Changes_to_the_Collection.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2010-05-24	Available
i3820 internet screens (current).pdf	Supplementary Document	Uploaded 2010-05-24	Available
SSA-3820_revised.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2010-05-20	Available
ssa3820.pdf	Supplementary Document	Uploaded 2010-05-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9538	Disability Report - Child (Paper)	Form and Instruction	Unchanged
179519	Disability Report - Child (Internet)	Other-Disability Report - Child (Internet)	Unchanged
179518	Disability Report - Child (EDCS)	Other-EDCS	Unchanged

ICR Details

OMB Control No: 0960-0577	ICR Reference No: 201005-0960-003
Status: Historical Active	Previous ICR Reference No: 200901-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Report - Child
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/04/2010
	Date Received in OIRA: 05/24/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2010	09/30/2010	09/30/2010
Responses	462,000	0	462,000
Time Burden (Hours)	318,633	0	318,633
Cost Burden (Dollars)	0	0	0

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Abstract: All 3 versions of this information collection, the paper SSA-3820, the online i3820, and the EDCS, which is input by the Claims Representative during an interview, collect the same information. The claimant has the option to complete the SSA-3820, complete the Internet application (i3820), or provide the information during a personal interview (EDCS. The claimant provides information on the limitations imposed by the alleged disability and the sources of medical and educational evidence. The information is used by the DDS evaluators to make a determination on the claim.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: null
   US Code: 42 USC 423 Name of Law: null
  

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 20154	04/23/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 32697	06/13/2007
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
Disability Report - Child (Paper)	SSA-3820-BK	Disability Report - Child
Disability Report - Child (Internet)
Disability Report - Child (EDCS)

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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	462,000	462,000	0	0	0	0
Annual Time Burden (Hours)	318,633	318,633	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: The public reporting burden has changed since the last request for clearance due to a more accurate estimate of the annual childhood application rate, which is lower than previously reported; an increase in the number of Internet-completed forms; a decrease in paper completion; and a more accurate estimate of number of respondents for SSA-3820's keyed into EDCS.

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Annual Cost to Federal Government: $10,761,616

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]? No

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: 05/24/2010

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