Social Security Administration (SSA) COVID-19 Symptoms Screener for Hearings

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Addendum - 0824 (Final).docx	Supplementary Document	Uploaded 2022-06-14	Repair queued
Supporting Statement - 0824 (Final).docx	Supporting Statement A	Uploaded 2022-06-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
254134	COVID Screener Questions and Appointment Check-In - Mobile Application	Other-Mobile Application Screens	New
254133	COVID Screener Questions and Appointment Check-In - Telephone Check-In	Other-Telephone Script	New
250661	COVID Screener Questionnaire	Other-Internet Screens	Modified

ICR Details

OMB Control No: 0960-0824	ICR Reference No: 202206-0960-005
Status: Historical Inactive	Previous ICR Reference No: 202203-0960-014
Agency/Subagency: SSA	Agency Tracking No:
Title: Social Security Administration (SSA) COVID-19 Symptoms Screener for Hearings
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Disapproved and continue	Conclusion Date: 10/13/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/14/2022
Terms of Clearance: Agency has requested that this ICR be discontinued. Pending ICR changes no longer relevant.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved	10/31/2022
Responses	179,580	0	179,580
Time Burden (Hours)	149,650	0	149,650
Cost Burden (Dollars)	0	0	0

---

Abstract: During the recent COVID-19 pandemic, SSA conducted its services almost exclusively online or by telephone, to protect the health of both the public and our employees. We took these measures in accordance with relevant Centers for Disease Control COVID-19 pandemic guidance, and to comply with existing Occupational Safety and Health Act provisions regarding workplace safety. We have resumed in-person hearings, as well as in-person field office visits. We use the current CDC suggested COVID-19 screening symptoms questionnaire for people coming in for in-person visits. The questionnaire for in-office visits is available via telephone, SSA mobile application (VIPr App), or kiosk. We require satisfactory answers to the screening questions, i.e., demonstrating that field office visitors did not demonstrate symptoms of COVID 19 and had not been exposed to someone with COVID-19, for the appointment to proceed. If the individuals answered yes to any of the COVID-19 screening questions, we offer them the option of completing their interview via video teleconferencing or using our online options, or we offer to reschedule their in-person interview for a later date.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 18453	03/30/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 33282	06/01/2022
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
COVID Screener Questionnaire
COVID Screener Questions and Appointment Check-In - Mobile Application
COVID Screener Questions and Appointment Check-In - Telephone Check-In

---

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: The burden increase from the Emergency Clearance Package stemmed from two changes. First, we doubled the burden for the COVID Screener Questionnaire from 179,580 to 359,160 as we only reflected 6-month figures during the Emergency clearance. Second, we added the VIPr Mobile Application and Express Interview Pre Screening modalities to this clearance package. SSA decided to move all Covid-19 Screeners under the same OMB Clearance Package. Due to this, the burden increased from 29,930 to 171,499. Note: The total burden reflected in ROCIS is 690,133, while the burden cited in #12 of the Supporting Statement is 171,499. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

---

Annual Cost to Federal Government: $110,316

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? Yes

---

Common Form ICR:  No

---

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: 06/14/2022

---