Disability Case Development Information Collections

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Sample CE Forms	Form and Instruction	Modified	Available
Addendum 0960-0555.docx	Supplementary Document	Uploaded 2026-04-17	Available
Supporting Statement - 0555 (final).docx	Supporting Statement A	Uploaded 2026-04-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9480	Category I , CE a) Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category)	Other-Samples of DDS CE Forms	Modified
280143	Category III - Pain/Other Symptoms/Impairment Information - Request for Third Party	Other-Request for Third Party Contact	New
280142	Category III - Pain/Other Symptoms/Impairment Information - Headache Questionnaire - Adult	Other-Headache Questionnaire (CLMT)	New
280141	Category III - Pain/Other Symptoms/Impairment Information - Seizure Witness Questionnaire – Adult	Other-Seizure Witness Questionnaire (3RD PTY)	New
279937	Category I, CE f) Text and Email CE Reminder Call Script/Letter	Other-DCPS Scheduling Text and Email Consent Script	New
279936	d) Travel time to and completion of CE	Other-Credentialing	New
241087	Category I, CE e) One-Time CE Claimant Telehealth Call Script (subset of "CE Forms Samples" category) and f) Text and Email CE Reminder Call Script/Letter	Other- THCE Agreement Call Script - Adult .	Modified
181780	Category III - Pain/Other Symptoms/Impairment Information - Seizure Questionnaire - Adult	Other-Seizure Questionnaire	Modified
179046	Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")	Form and Instruction	Modified	Sample CE Forms
179022	Category II - MER, ERE & Connect Direct transmission of MER forms (subset of "MER Samples" category)	Other-ERE Transmission of "MER Samples" Category	Modified
179020	Category II - MER Paper Submissions (subset of "MER Samples") category	Other-Sample of MER forms	Modified
179019	Category I, CE c) Claimants re Report to Medical Provider (subset of "CE Forms Samples" category)	Other-Sample of state DDS Claimant Report Letter/Form	Modified
179018	Category I, CE b) Claimant/Appointment Letter Information (subset of "CE Forms Samples" category)	Other-CE Appointment Notice to Claimant (Adult)	Modified
179017	Category I, CE a) Medical Evidence from CE Providers (Electronic Transmission through ERE; subset of "CE Forms Samples" category)	Other-Sample of types of information sent through ERE; electroni	Modified

ICR Details

OMB Control No: 0960-0555	ICR Reference No: 202604-0960-004
Status: Received in OIRA	Previous ICR Reference No: 202412-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Case Development Information Collections
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/29/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2026
Responses	22,948,884	18,905,536
Time Burden (Hours)	5,755,742	4,579,535
Cost Burden (Dollars)	0	0

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Abstract: State Disability Determination Services (DDS) collect the information necessary to administer the Social Security Disability Insurance and SSI programs. They collect medical evidence from consultative examination (CE) sources; credential information from CE source applicants; and medical evidence of record (MER) from claimants’ medical sources. The DDSs collect information from claimants regarding medical appointments, pain, symptoms, and impairments. The respondents are medical providers, other sources of MER, and disability claimants.

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Authorizing Statute(s): US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 421 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
   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:
	91 FR 9671	02/26/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 22195	04/24/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 14

table that charts list of burden

IC Title	Form No.	Form Name
Category I , CE a) Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category)
Category I, CE f) Text and Email CE Reminder Call Script/Letter
Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")	N/A	Sample CE Forms
Category I, CE a) Medical Evidence from CE Providers (Electronic Transmission through ERE; subset of "CE Forms Samples" category)
Category I, CE b) Claimant/Appointment Letter Information (subset of "CE Forms Samples" category)
Category I, CE c) Claimants re Report to Medical Provider (subset of "CE Forms Samples" category)
Category I, CE e) One-Time CE Claimant Telehealth Call Script (subset of "CE Forms Samples" category) and f) Text and Email CE Reminder Call Script/Letter
Category II - MER Paper Submissions (subset of "MER Samples") category
Category II - MER, ERE & Connect Direct transmission of MER forms (subset of "MER Samples" category)
Category III - Pain/Other Symptoms/Impairment Information - Headache Questionnaire - Adult
Category III - Pain/Other Symptoms/Impairment Information - Request for Third Party
Category III - Pain/Other Symptoms/Impairment Information - Seizure Questionnaire - Adult
Category III - Pain/Other Symptoms/Impairment Information - Seizure Witness Questionnaire – Adult
d) Travel time to and completion of CE

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ICR Summary of Burden

table that charts list 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	22,948,884	18,905,536	0	0	4,043,348	0
Annual Time Burden (Hours)	5,755,742	4,579,535	0	0	1,176,207	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: When we last cleared this IC in 2023, the burden was 4,501,999 hours. However, we are currently reporting a burden of 5,534,604 hours. This change stems from the removal of several forms, the addition of other forms, the revisions to forms, and addition of further CE information collections. In addition, we have also updated our Disability Case Processing System, all of which affected the total burden for this information collection. These figures represent current Management Information data. * Note: The total burden reflected in ROCIS is 5,709,811, while the burden cited in #12 of the Supporting Statement is 5,534,604. This discrepancy is because the ROCIS burden also reflects learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

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Annual Cost to Federal Government: $509,672,868

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: 04/29/2026

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