Ohio Direct Referral Demonstration (ODRD)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Invitation and Consent to Join the Ohio Direct Referral Demonstration	Form and Instruction	New	Available
Invitation and Consent to Join the Ohio Direct Refferal Demonstration	Form and Instruction	New	Available
ODRD Cooperative Agreement Project Description Final.docx	Supplementary Document	Uploaded 2019-11-22	Available
Jointly Financed Cooperative Arrangement between The Soical Security Adm.._.pdf	Supplementary Document	Uploaded 2019-11-22	Available
Supporting Statement Part B - NEW (ODRD) - Revised.docx	Supporting Statement B	Uploaded 2020-01-23	Available
Supporting Statement Part A - NEW (ODRD) - Revised.docx	Supporting Statement A	Uploaded 2020-01-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238674	Invitation to Participate and Consent Form –Representative Payee (on behalf of the Participant)	Form and Instruction	New	Invitation and Consent to Join the Ohio Direct Referral Demonstration
238674	Invitation to Participate and Consent Form –Representative Payee (on behalf of the Participant)	Other-Letter	New
238668	Invitation to Participate and Consent Form – Participant Only (no Representative Payee	Form and Instruction	New	Invitation and Consent to Join the Ohio Direct Refferal Demonstration
238668	Invitation to Participate and Consent Form – Participant Only (no Representative Payee	Other-Letter	New

ICR Details

OMB Control No: 0960-0815	ICR Reference No: 201911-0960-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Ohio Direct Referral Demonstration (ODRD)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/24/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/22/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	36 Months From Approved
Responses	750	0	0
Time Burden (Hours)	76	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: SSA is requesting clearance to collect data necessary to conduct a random assignment evaluation of volunteers in Ohio who enroll in Ohio Direct Referral Demonstration (ODRD). SSA and Opportunities for Ohioan’s with Disabilities (OOD) will conduct the ODRD to test the effectiveness of providing direct referrals to vocational rehabilitation services for 18 and 19 year-olds who are, or may become, Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) recipients. The participants in the demonstration will be individuals ages 18 and 19 at the time of enrollment, who are either (1) applying for SSDI or SSI or (2) undergoing an age-18 redetermination of SSI eligibility. The ODRD is a joint effort by SSA and OOD’s Division of Disability Determination (DDD), and Ohio’s Bureau of Vocational Rehabilitation (BVR). ODRD builds off other work by SSA exploring ways to improve the adult employment outcomes and financial independence for SSI recipients and SSI and SSDI applicants who are in the process of transitioning to adulthood. ODRD tests the effects of a direct referral to vocational rehabilitation services for individuals aged 18 or 19 who are in the process of applying for, or undergoing an evaluation to, retain SSDI benefits or SSI payments. We will use the data collected to answer the following questions: What effect did the intervention have on receipt of Ohio’s BVR services? What effect did the intervention have on employment outcomes, such as job placement and earnings? What is the length of time from application to eligibility decision? What general vocational rehabilitation outcomes did participants achieve? What was the number of closed cases resulting in employment and what was the number of cases closed for other reasons? SSA is seeking OMB clearance for the data collection related to enrollment and evaluation of the ODRD. Using SSA claims records, which DDD will access to perform disability determinations for SSA, DDD will attempt to recruit at least 750 participants. DDD will obtain signed, informed consent from individuals who want to participate in the demonstration. Recruitment for the ODRD will require two forms: (1) a new Invitation to Participate and Consent form, and (2) Form SSA-3288, Consent for Release of Information (OMB # 0960 0566). ODD will send the new Invitation to Participate and Consent form to young adult disability recipients, whose claim we sent to the DDD for a continuing disability review, and applicants to see if they are interested in participating in the demonstration. The ODRD Invitation to Participate and Consent forms will meet the informed consent requirements in the Social Security Act and SSA regulations. Specifically, they include language explaining the study as well as potential benefits and harms. SSA will use administrative records systems and BVR data to evaluate the effect of the demonstration. This is a onetime collection of information, and there are no surveys or additional data collections for the ODRD. This collection is voluntary, and participation in this demonstration will have no impact on respondents’ disability determination, benefits, or SSI payments. The respondents are individuals aged 18 or 19 who are in the process of applying for, or undergoing an evaluation, to obtain or retain SSDI benefits or SSI payments.

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Authorizing Statute(s): None

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:
	84 FR 48204	09/12/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 64177	11/20/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Invitation to Participate and Consent Form – Participant Only (no Representative Payee	N/A	Invitation and Consent to Join the Ohio Direct Refferal Demonstration
Invitation to Participate and Consent Form –Representative Payee (on behalf of the Participant)	N/A	Invitation and Consent to Join the Ohio Direct Referral Demonstration

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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	750	0	0	750	0	0
Annual Time Burden (Hours)	76	0	0	76	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This new information collection increases the public reporting burden. See #12 for the burden figures.

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Annual Cost to Federal Government: $30,031

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: 11/22/2019

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