Disability Report - Child

Forms and Documents

Document Name	Status
Form SSA-3820-BK Disability Report - Child (Paper) SSA-3820 Form	Modified
Justification for a Non-Substantive Change - 0577 (DDRC).docx Justification for No Material/Nonsubstantive Change	2024-11-06
Supporting Statement - 0577 (Revised).docx Supporting Statement A	2022-12-21

IC Document Collections

IC ID	Document Title	Status
9538	Disability Report - Child (Paper) SSA-3820 Form	Modified
272185	Disability Determination Ready Claim (DDRC) Certification Statement (for DDRC Pilot) Other-Certification Statement Form	New
179519	Disability Report - Child (Internet) Other-Disability Report - Child (Internet)	Unchanged
179518	Disability Report - Child (EDCS) Other-EDCS	Unchanged

ICR Details

OMB Control No: 0960-0577	ICR Reference No: 202411-0960-003
Status: Received in OIRA	Previous ICR Reference No: 202402-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Report - Child
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/06/2024

	Requested	Previously Approved
Expiration Date	02/28/2026	02/28/2026
Responses	710,288	355,144
Time Burden (Hours)	627,421	621,502
Cost Burden (Dollars)	0	0

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Abstract: SSA uses Form SSA-3820-BK to collect information about a child’s condition from treating sources or other medical sources of evidence. The State Disability Determination Services (DDS) evaluators use the information from Form SSA-3820-BK to develop medical and school evidence, and to assess the alleged disability. The information, together with medical evidence, forms the evidentiary basis upon which SSA makes its initial disability evaluation. The respondents are claimants seeking SSI childhood disability payments. Applicants can complete and print Form SSA-3820-BK and mail to SSA, or take the notification page (generated after completing the i3820) to their local Social Security field office (FO). The notification page serves as a back-up alert to the FOs that an applicant transmitted an internet disability report. When claimants do not complete an i3820, FO employees use the Electronic Disability Collect System (EDCS) internal collection process to key information provided by claimants onto EDCS screens to establish a database for the DDS adjudicators. We are submitting a Change Request to append the Disability Determination Ready Claim (DDRC) Certification Statement to this information collection in anticipation of respondents using it for the DDRC pilot.

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Authorizing Statute(s): US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 1383 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:
	84 FR 31972	07/03/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 48694	09/16/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Disability Determination Ready Claim (DDRC) Certification Statement (for DDRC Pilot)
Disability Report - Child (EDCS)
Disability Report - Child (Internet)
Disability Report - Child (Paper) SSA-3820	SSA-3820-BK	Disability Report - Child

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ICR Summary of Burden

	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	710,288	355,144	0	355,144	0	0
Annual Time Burden (Hours)	627,421	621,502	0	5,919	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: We are adding a new, voluntary, Certification Statement for the use of respondents during the pilot of the new Disability Determination Ready Claim (DDRC). This new Certification Statement will increase the public reporting burden for those who choose to request the new process.

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Annual Cost to Federal Government: $751,220

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: 11/06/2024

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