Justification for Non-Substantive Change for Form SSA-3192

Justification for Non-Substantive Changes for

Form SSA-3192

Application and Statement In Connection With

Medical Parking at SSA Headquarters Buildings in Baltimore, MD

41 CFR 101.20-104.2

OMB No. 0960-0624

Background: As per section 41 CFR 101.20-104.2 of the Code of Federal Regulations, Social Security Administration (SSA) employees and contractors with qualifying medical conditions who park at SSA-owned and -leased facilities are eligible to apply for an SSA medical parking permit.

SSA uses three forms as part of this program: Form SSA-3192, the Application and Statement (the person seeking the permit completes this when they first apply for the medical parking space); Form SSA-3193, the Physician’s Report (the applicant’s physician completes this to verify the medical condition and also provides medical evidence that supports the diagnosis); and Form SSA-3194, the Renewal Certification (medical parking permit holders complete this to verify their continued need for the permit). The respondents are SSA employees and contractors seeking medical parking permits and their physicians.

Change: We are changing Form SSA-3192, second paragraph, first sentence to read as follows:

In support of your application for medical parking, you must submit Form SSA-3193, Physician’s Report, and include…………..

Justification: Referencing the companion form (SSA-3193) by form number and name improves clarity and readability on the application’s instructions of the SSA-3192, and makes it easier to understand for the respondents. This change does not affect the burden of the information collection instrument.