Addendum to the Supporting Statement for 0960-0072

Addendum to the Supporting Statement for Form SSA-454-BK & SSA-454-ICR

Continuing Disability Review Report

20 CFR 404.1589 & 416.989

OMB No. 0960-0072

Revisions to the Collection Instrument

We used the previously approved OMB form SSA-454-ICR, Continuing Disability Review Report in a pilot to the public. We sent out 300 SSA-454-ICR forms to individuals who had a CDR medical diary due. Based on the responses we received, we made several changes to the form. We have detailed the changes below. Most of the changes involved providing clearer instructions to the respondents.

The SSA-454-ICR is the only collection instrument we are changing from the last OMB approval. The SSA-454-BK and Electronic Disability Collect System (EDCS) screens remain the same.

The form is set up in sections that deal with different issues regarding an individual’s current medical conditions. Each section starts with a main question, followed by clarifying questions, if needed. We added instructions for where the respondent should go next, based on the response for the question. We provided clearer instructions because, during the pilot, we found that respondents were unnecessarily answering some questions. An example if the instructions added are Section 4 question 4.B. We added the instruction that if the respondent answered “No” go to 4.D. During the pilot, we found most respondents answered question 4.C even though it was not required.

Changes made to the 454-ICR (10-2010)

We added Bar Codes at top and Data Scan Lines for data gathering purposes. The information contained in these fields will electronically direct where the data should go in EDCS (e.g. case number, document type, etc)

Section “For SSA Use Only”

1. We added three more Exception Boxes for future use. We have no immediate plans for the use of these boxes, but experience has taught us to add additional boxes for potential future use.

2. We moved the beneficiary/recipient name and SSN to this section because it makes sense to have the identifying information at the beginning of the form.

Section 1 – Information about the Disabled Person

We reworded and renumbered the questions in this section for clarity. We provided more detailed instructions based on the respondent’s answers to make the form easier to follow.

Section 2 – Medical Conditions

1. We added space for two additional medical conditions because, based on the pilot, there were many respondents that listed more than five conditions.

2. We added instructions to add any addition conditions (more than seven) to the remarks section.

Section 3 – Medical Records

Questions 3.C and 3.D, we included the remark “If yes, someone will contact you for the additional information.” The SSA field office captures the additional information during the interview portion of the CDR review.

Section 4 – Work, Education and Training

In question 4.B, we added instructions to go to 4.C if answered yes, and go to 4.D if answered no because during the pilot we found respondents completed 4.C when there was no need to respond.

Section 6 – Tests and Medicines

1. We added a question regarding medical tests the individual may have had in the last 12 months. This question was not on the pilot form; however, it is information necessary for the CDR review.

2. We reduced the number of spaces for medicines because we found that most respondents did not need space to list nine medicines. In question 6.D, we added the instruction to add additional medicines to remarks if there were more than seven medicines currently taken.

Section 7 – Daily Activities – no changes

Section 8 – Remarks

We added instruction to go to Section 9 when Remarks Section was completed.

Section 9 – Contacts

We moved the date completed tot the bottom of the page and added instructions regarding where to go next, depending upon the answer to question 9.B.

Additional Revisions to the SSA-454

SSA's Office of the General Counsel is conducting a systematic review of SSA's Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on this form.

Implementation Plan

Upon approval of the revised SSA-454-ICR, SSA’s Office of Publications Management will go out to bid for a print vendor to print and mail the cover letter, SSA-454-ICR, SSA-827, SSA pamphlet “How We Decide if You Are Still Disabled” -- SSA 05-10053 (ICN 462555) and a return envelope to individuals schedule for a medical continuing disability review.

The selected individuals will complete and return the forms to SSA’s Wilkes Barre Data Operations Center (WBDOC). The WBDOC scans the data into EDCS and notifies the field office that the information is available. When necessary, claims representatives (CR) will contact the individuals who completed the SSA-454-ICRs to ask additional questions and enter the information into the EDCS screens. The Agency has determined the most efficient way to collect information is to ask CDR subjects to provide basic information on the SSA-454-ICR and then allow trained CRs to interview the subjects to obtain more complex information.

We anticipate that the national usage of this form will begin in the fall of 2011.

Plans beyond 2011 call for creation of an Internet version of the Continuing Disability Review Report.