Nonsubstantive Change 0960-0805

Justification for Non-Substantive Changes for Form SSA-3385

REPORT OF ADULT FUNCTIONING-EMPLOYER

20 CFR 404.1512 and 20 CFR 416.912

OMB NO. 0960-0805

Background

The Social Security Administration (SSA) uses Form SSA-3385 to provide information

about the employee’s day-to-day function in the work setting. It is important

because it will help us determine the effects of the person’s impairment on his or her

disability status. The form is in English and Spanish.

Revisions to the SSA-3385:

• Change #1: We are revising the language on Page 1, first sentence

  • Old Language: One of your former employees

• New Language: One of your current/former employees

Justification #1: We made the change due to component suggestion.

• Change #2: We are removing the sentence “If you cannot give us all the information we need” on Page 1, third sentence.

Justification #2: We made the change because this is an employer form and we will get information from the employer to complete this form. We made this change due to component suggestion.

• Change #3: We are revising the language on Page 1, Second bullet

  • Old Language: Please respond to all of the items in Sections A and B. If you do not know the answer, please enter "do not know".

• New Language: Please respond to all of the items in Sections B and C. If you do not know the answer, please enter "do not know".

Justification #3 We made this change due to component suggestion. Section A is usually pre-filled.

• Change #4: We are revising the language on Page 1, third bullet,

  • Old Language: The items in Section B include questions intended to help you understand the information we are requesting. Please respond to the questions and include any additional information you think would be helpful to us.

• New Language: The items in Section C include questions intended to help you understand the information we are requesting. Please respond to the questions and include any additional information you think would be helpful to us.

Justification #4: We made this change due to component suggestion. Section C is the section that discusses questions to help you understand the information we are seeking.

• Change #5: We are changing a punctuation error on Page 4, question 9, under “Describe the individual’s ability…,” should end in question mark and not a period.

Justification #5: We made this change to correct punctuation, and for clarity due to component suggestion.

• Change #6: We are revising the language on Page 5, Question 12/

  • Old Language: Describe the individual's ability to interact with others. Did the individual cooperate with you and co-workers; respond appropriately

• New Language: Describe the individual’s ability to interact with others. Did the individual cooperate with you and co-workers, and respond appropriately?

Justification #6: We made this change to correct punctuation and for clarity due to component suggestion. We utilized comma instead of semi-colon, added the word and, and ended sentence with question mark.

SSA will implement the changes to the SSA-3385 upon OMB approval.

This action does not affect the public reporting burden.