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	Modified	Repair queued
Supporting Statement 0960-0777.docx	Supporting Statement A	Uploaded 2010-08-12	Available
Addendum to Supporting Statement.docx	Supplementary Document	Uploaded 2010-07-23	Repair queued

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	Modified
192017	Request for Accommodation in Communication Method (paper form)	Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0777	ICR Reference No: 201006-0960-003
Status: Historical Active	Previous ICR Reference No: 201002-0960-016
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Accommodation in Communication Method
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: 09/15/2010
	Date Received in OIRA: 08/12/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	36 Months From Approved	09/30/2010
Responses	2,500	0	2,500
Time Burden (Hours)	438	0	458
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, they will complete Form SSA-9000, the Request for Accommodation in Communication Method. The SSA-9000 asks 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.

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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 30897	06/02/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 49013	08/12/2010
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	2,500	0	0	0	0
Annual Time Burden (Hours)	438	458	0	0	-20	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: Since OMB approved the emergency clearance for this new ICR in February 2010, we have revised the burden estimate based on actual requests and the method of response used by the public. Where we estimated 20 percent of the respondents would use the paper form, we found, based on actual data, only 10 percent of the respondents are using the paper form. We have adjusted the total burden accordingly to account for the difference in response time between the two collection methods.

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Annual Cost to Federal Government: $188,387

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: 08/12/2010

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