Justification for the Non-Substantive Changes to 0960-0681

Justification for Non-Substantive Changes to Form SSA-3373

Function Report - Adult

20 CFR 404.1512 and 416.912

OMB No. 0960-0681

Background

Generally, SSA sends the paper Form SSA-3373 to claimants to collect information about a disability applicant’s or recipient’s impairment-related limitations and ability to function. Additionally, SSA provides a PDF version of the SSA-3373 on our website for the public to print, complete, and submit to SSA for processing. At this time, claimants must print the blank PDF and fill it out using pen & ink, or they need to use a typewriter to complete the form. As some handwriting is difficult to read, or illegible, these non-fillable versions of the form are inefficient and ineffective since SSA employees who cannot read the submitted form must re-contact the respondent prior to processing. In addition, the use of typewriters has decreased significantly, as other tools, such as personal computing devices, have increased in use.

SSA developed a fillable, printable version of the SSA-3373, as some individuals may find it easier to use. The fillable version allows the respondents to complete the form electronically using a personal computer, or other computing device, print the completed form, and submit it to SSA. We developed this fillable version, as we want to ensure SSA provides effective communication and remains in compliance with the requirements of 45 CFR 85.51 of the Code of Federal Regulations and section 504 of the Rehabilitation Act of 1973. We propose the fillable PDF version as a more accessible modality. In addition, the new fillable modality will enhance our electronic services and recordkeeping efforts.

Revisions to the Information Collection

SSA intends to provide Form SSA-3373 in a fillable PDF file on our website, in place of the non-fillable PDF version we currently provide. We propose to make all form entries fillable. This change will allow the respondents to continue to print and complete the form by hand, or, alternatively, complete the form using a computing device, such as a personal computer or handheld (mobile) device, print, and submit to SSA for processing.

After OMB approves the addition of the new fillable version of the form, SSA will phase out the standard PDF versions from our Internet and Intranet websites and replace them with the fillable PDF file.