Authorization to Disclose Information to the Social Security Administration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-827 Authorization To Disclose Information To The Social Security Administration	Form and Instruction	Modified	Available
Addendum - 0623 (Final).docx	Supplementary Document	Uploaded 2021-03-02	Available
Addendum - 0623 (Final).docx	Supplementary Document	Uploaded 2021-03-02	Repair queued
Supporting Statement - 0623 (Final).docx	Supporting Statement A	Uploaded 2021-03-02	Available
Supporting Statement - 0623 (Final).docx	Supporting Statement A	Uploaded 2021-03-02	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9639	SSA-827 with wet signature(paper version) or EDCS Screens with verbal attestation (Intranet version)	Form and Instruction	Modified	Authorization To Disclose Information To The Social Security Administration
9639	SSA-827 with wet signature(paper version) or EDCS Screens with verbal attestation (Intranet version)	Other-Revised PA & PRA Statements	Modified
197969	e827 - Internet Version (eAuthorization)	Other-Internet Screens	Modified

ICR Details

OMB Control No: 0960-0623	ICR Reference No: 202101-0960-005
Status: Active	Previous ICR Reference No: 201703-0960-023
Agency/Subagency: SSA	Agency Tracking No:
Title: Authorization to Disclose Information to the Social Security Administration
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: 04/29/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/02/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved	04/30/2024
Responses	5,245,077	0	5,245,077
Time Burden (Hours)	804,359	0	804,359
Cost Burden (Dollars)	0	0	0

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Abstract: Sections 223(d)(5)(A) and 1614(a)(3)(H)(i) of the Social Security Act require claimants to provide medical and other evidence the Commissioner of Social Security may require to prove they are disabled. SSA must obtain sufficient evidence to make eligibility determinations for Title II and Title XVI payments. Therefore, the applicant must authorize release of information from various sources to SSA. The applicants use Form SSA 827, or the Internet counterpart, e827, to provide consent for the release of medical records, education records, and other information related to their ability to perform tasks. Once the applicant completes Form SSA-827, or the e827, SSA or the State DDS sends the form to the designated source(s) to obtain pertinent records. The respondents are applicants for Title II and Title XVI disability payments.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 1382c Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: 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:
	85 FR 86638	12/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 12068	03/01/2021
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
SSA-827 with wet signature(paper version) or EDCS Screens with verbal attestation (Intranet version)	SSA-827	Authorization To Disclose Information To The Social Security Administration
e827 - Internet Version (eAuthorization)

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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	5,245,077	5,245,077	0	0	0	0
Annual Time Burden (Hours)	804,359	804,359	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: $1,651,179

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? No

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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: 03/02/2021

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