Sections 223(d)(5)(A) and 1631(e)(1) of the Act require Supplemental Security Income (SSI) claimants to furnish medical and other evidence to prove they are disabled. SSA uses Form SSA-3820-BK to collect information regarding a child applying for SSI disability payments. The information we collect on the SSA-3820-BK then provides the State Disability Determination Services (DDS) adjudicators a detailed explanation of a childâs medical history that is essential to the disability determination. SSA uses Form SSA-3820-BK to collect contact and biographic information about a child. It also includes details pertaining to the childâs condition including medical treating sources, medications being taken, medical tests, educational background, and work history if relevant. The State (DDS) evaluators use the information from Form SSA-3820-BK, including its electronic versions, to request and develop medical and school evidence, and to assess the alleged disability. The information collected on the form, together with medical evidence and other sources of non-medical evidence, provides the evidentiary basis upon which SSA makes its initial disability evaluation. The respondents are the responsible adult(s) applying on behalf of the child, such as the parents, guardians, and other caretakers who petition SSI childhood disability for initial and reconsideration decisions.
US Code:
42 USC 423
Name of Law: Social Security Act
US Code:
42 USC 1383
Name of Law: Social Security Act
When we last cleared this IC in 2022, the burden was 621,502 hours. We are currently reporting a burden of 706,087 hours. Although there is no change to the burden time per response, this change stems from a decrease in the number of paper Form SSA-3820 submissions that generally take less time to complete, and an increase in the number of electronic (ECDS and i3820) submissions, which take longer to complete. Although the number of responses decreased from 355,144 to 353,236, SSA did not take any action to cause this change, as this figure represents normal fluctuation in respondents for this information collection. These figures represent current management information data.
SSA is only able to provide the total number of paper and electronic Form SSA 3820 and i3820 responses completed. SSA is unable to fully break down the method in which the SSI application is finalized or completed and submitted into the electronic disability case file necessary for adjudication, as we do not track that information. There is a possibility that a respondent physically takes a paper SSA-3820 to the FO, finalizes the i3820 process at the FO, or schedules an in person appointment at the FO for the technician to input data into the EDCS. This information collection is only able to predict how many respondents physically traveled to the FO. SSA predicts that 50% of respondents travel to the FO to complete the SSA-3820 and/or its finalization process verses the remaining 50% who may utilize teleservice methods. We are working on ways to obtain more precise data to make this estimate.
SSA systems and operations provided additional data and reference points for SSA employee information collection and processing time and systems development, updating and maintenance. While the total annual cost to the federal government is significantly higher when compared to the last information collection in 2022, the current information collection reflects more accurate and relevant data related to the SSA-3820-BK and i3820 forms.
* Note: The total burden reflected in ROCIS is X, while the burden cited in #12 of the Supporting Statement is 706,087. This discrepancy is because the ROCIS burden reflects the following components: field office and telephone wait time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.
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.
Form SSA-3820-BK Disability Report - Child
Addendum - 0577 (Final).docx
Disability Report - Child (Paper) SSA-3820-BK