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

ICR 202206-0960-005

OMB: 0960-0824

Federal Form Document

Forms and Documents
Supplementary Document
Supporting Statement A
ICR Details
0960-0824 202206-0960-005
Received in OIRA 202203-0960-014
Social Security Administration (SSA) COVID-19 Symptoms Screener for Hearings
Revision of a currently approved collection   No
Regular 06/14/2022
  Requested Previously Approved
36 Months From Approved 06/30/2022
1,037,268 179,580
690,133 149,650
0 0

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.

US Code: 42 USC 405 Name of Law: Social Security Act

Not associated with rulemaking

  87 FR 18453 03/30/2022
87 FR 33282 06/01/2022

  Total Request 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 1,037,268 179,580 0 0 857,688 0
Annual Time Burden (Hours) 690,133 149,650 0 0 540,483 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
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.

Faye Lipsky 410 965-8783 [email protected]


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:
    (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;
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.

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