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	Removed	Repair queued
Addendum - 0777.docx	Supplementary Document	Uploaded 2013-09-13	Available
Supporting Statement - 0777.docx	Supporting Statement A	Uploaded 2013-09-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192018	Request for Accommodation in Communication Method	Other-Intranet (internal SSA) screens	Modified
192017	Request for Accommodation in Communication Method (paper form)	Form and Instruction	Removed

ICR Details

OMB Control No: 0960-0777	ICR Reference No: 201304-0960-011
Status: Historical Active	Previous ICR Reference No: 201012-0960-003
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: 11/06/2013
	Date Received in OIRA: 09/13/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	36 Months From Approved	11/30/2013
Responses	1,417	0	2,500
Time Burden (Hours)	472	0	438
Cost Burden (Dollars)	0	0	0

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Abstract: SSA supplies a designated telephone number allowing Social Security applicants, beneficiaries, recipients, and representative payees who are blind or visually-impaired to tell SSA which of the following seven methods of communication they want SSA to use when it sends them benefit notices and other related communications: (1) standard print notice by first class mail, (2) standard print mail with a follow-up telephone call, (3) certified mail, (4) Braille, (5) Microsoft Word file on data compact disk (CD), (6) large print (18-point font) or (7) audio CD. However, respondents who want to receive notices from SSA through a communication method other than the seven methods listed above use Form SSA-9000 to: (1) describe the type of accommodation they want, (2) disclose their condition necessitating the need for a different type of accommodation, and (3) explain why none of the seven methods described above are sufficient for their needs. SSA uses Form SSA-9000 to determine, based on applicable law and regulation, whether to grant an individual's request for an accommodation based on their blindness, other visual impairment, and as applicable, another disabling condition. SSA collects this information electronically through either an in-person interview or a telephone interview during which the SSA employee keys in the information on Intranet screens. The respondents are Social Security applicants, beneficiaries, recipients, and representative payees who are blind or visually impaired and who ask SSA to send notices and other communications in an alternative method besides the seven modalities we described above.

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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:
	78 FR 36291	06/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 54363	09/03/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Request for Accommodation in Communication Method	SSA-9000-F6	Request for Accommodation
Request for Accommodation in Communication Method (paper form)	SSA-9000	Request for Accommodation in Communication Method

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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	1,417	2,500	0	-250	-833	0
Annual Time Burden (Hours)	472	438	0	-63	97	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We based our previous burden estimate on our projection of respondents who may want to use the new form. However, after the initial implementation of the form, the number of respondents dropped considerably. Therefore, we based our new estimate on actual usage for 2012. In addition, while we offer a paper version of the SSA-9000, none of the respondents used it. Rather, since implementing this process, the respondents have only used the telephone or in-person interview option. Therefore, we are no longer showing burden for the paper version, but we will keep the paper version available in case respondents choose to use it. Finally, we increased our time estimate for completing the interview from 10 minutes to 20 minutes, as we found it takes a bit longer for respondents to answer the questions than we initially anticipated in 2010.

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Annual Cost to Federal Government: $60,000

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]? No

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: 09/13/2013

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