Vocational Rehabilitation Provider Claim

Forms and Documents

Document Name	Status
Form SSA-199 Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199 Form	Modified
Addendum - 0310.docx Supplementary Document	2019-02-18
Supporting Statement - 0310.docx Supporting Statement A	2019-02-18

IC Document Collections

IC ID	Document Title	Status
9208	Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199 Form	Modified
45274	Preparing Causality Statements Other-Causality Statements	Modified
45273	Certifying Adherence to Cost Containment Policies and Procedures Other-Written Certification	Modified

ICR Details

OMB Control No: 0960-0310	ICR Reference No: 201810-0960-014
Status: Historical Active	Previous ICR Reference No: 201507-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Vocational Rehabilitation Provider Claim
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: 06/14/2019
	Date Received in OIRA: 02/18/2019
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved	06/30/2019
Responses	13,080	0	13,080
Time Burden (Hours)	5,320	0	5,320
Cost Burden (Dollars)	0	0	0

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Abstract: State Vocational Rehabilitation (VR) agencies submit Form SSA–199 to SSA to obtain reimbursement of costs incurred for providing VR services. SSA requires state VR agencies to submit reimbursement claims for the following categories: (1) Claiming reimbursement for VR services provided; (2) certifying adherence to cost containment policies and procedures; and (3) preparing causality statements. The respondents mail the paper copy of the SSA 199 to SSA for consideration and approval of the claim for reimbursement of cost incurred for SSA beneficiaries. For claims certifying adherence to cost containment policies and procedures, or for preparing causality statements, state VR agencies submit written requests as stipulated in SSA’s regulations within the Code of Federal Regulations. In most cases, SSA requires adherence to cost containment policies and procedures as well as causality statements prior to determining whether to reimburse the state VR agencies. SSA uses the information on the SSA-199, along with the written documentation, to determine whether or not, and how much, to pay the state VR agencies under SSA’s VR program. Respondents are state VR agencies who offer vocational and employment services to Social Security and Supplemental Security Income recipients.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: The Social Security Act
   US Code: 42 USC 422 Name of Law: The Social Security Act
   US Code: 42 USC 1382d Name of Law: The Social Security 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:
	83 FR 56133	11/09/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 371	01/25/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Certifying Adherence to Cost Containment Policies and Procedures
Preparing Causality Statements
Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199	SSA-199	Vocational Rehabilitation Provider Claim

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ICR Summary 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	13,080	13,080	0	0	0	0
Annual Time Burden (Hours)	5,320	5,320	0	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $45,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 02/18/2019

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