Justification for the Non-Substantive Changes - 0960-0662

Justification for Non-Substantive Changes to

Form HA-1151 Medical Source Statement of Ability

To Do Work-Related Activities (Physical) and

Form HA-1152 Medical Source Statement of Ability

To Do Work-Related Activities (Mental)

20 CFR 404.1512-404.1513, 416.912-416.913, 404.1517, 416.917

OMB No. 0960-0662

Justification for Non-Substantive Changes to the HA-1152

Background: SSA is revising the criteria for evaluating mental impairments in adults and children under Titles II and XVI. The final rule, RIN 0960-AF69, which we published on September 26, 2016, at 81 FR 66137, will become effective on January 17, 2017.

Form HA-1152 seeks opinions from a claimant’s medical provider regarding a claimant’s mental impairments. Pursuant to the new rule, we adjusted the definitions of the ratings used to identify a claimant’s limitation, and specified a claimant’s abilities, which the provider should consider. The list of revisions and explanation of the revisions are below:

• Change #1: We updated the definitions for “none,” “mild,” “moderate,” “marked,” and “extreme” with the new definitions.

Justification #1: We seek to be consistent with the new definitions for these terms, and included the updated definitions for them from the Final Rule cited above.

• Change #2: We are including page numbers at the top of each page.

Justification #2: We believe these page numbers will help respondents answer the questions in order.

• Change #3: For question #3, we added specific abilities to consider within the parentheses: “(such as the abilities to concentrate, persist, or maintain pace and adapt or manage oneself).”

Justification #3: The first two questions on this form adequately ask about the claimant’s mental functioning in the first two areas of our new regulation, but not the last two. By providing these examples, we hope to receive more specifics regarding the claimant’s mental functional limitations.

We plan to make this updated available with our January 14, 2017 systems release, for implementation on January 17, 2017 (upon the effective date of the Final Rule). We will make these revisions immediately to ensure the information collected is most relevant for the hearing operations adjudication needs, and will best serve the respondents.

Future Plans: After we publish the Final Rule, we intend to submit more comprehensive changes to this form. However, due to current time constraints, and the need to have the above updates to the form in place prior to the January 17, 2017 effective date, we will make any further adjustments later.