Medical Permit Parking Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-3192 (Contract Application and Statement	Form and Instruction	Modified	Available
Form SSA-3193 (Physicia Renewal Certification	Form and Instruction	Modified	Available
Form SSA-3193 SSA-3193 (Contractor Applicant)	Form and Instruction	Modified	Available
Supporting Statement - 0624 (final).docx	Supporting Statement A	Uploaded 2026-07-31	Available
Addendum - 0624 (final).docx	Supplementary Document	Uploaded 2026-07-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9641	Application and Statement (Contractor Applicant)- SSA-3192	Form and Instruction	Modified	Application and Statement
9641	Application and Statement (Contractor Applicant)- SSA-3192	Other-Revised PA Statement	Modified
186166	SSA-3193 (Physician)	Form and Instruction	Modified	Renewal Certification
186166	SSA-3193 (Physician)	Other-Revised PA Statement	Modified
186165	SSA-3193 (Contractor Applicant)	Form and Instruction	Modified	SSA-3193 (Contractor Applicant)
186165	SSA-3193 (Contractor Applicant)	Other-Revised PA Statement	Modified

ICR Details

OMB Control No: 0960-0624	ICR Reference No: 202606-0960-011
Status: Received in OIRA	Previous ICR Reference No: 202007-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Medical Permit Parking Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/31/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	623	937
Time Burden (Hours)	497	900
Cost Burden (Dollars)	0	0

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Abstract: SSA employees and contractors with a qualifying medical condition who park at SSA owned and leased facilities may apply to receive a medical parking permit. SSA uses two forms for this program: (1) the SSA-3192, the Application and Statement, which an individual completes when first applying for the medical parking space; and (2) the SSA 3193, the Physician’s Report, which the applicant’s physician completes to verify the medical condition after the individual completes the top portion and brings the form to the physician. The respondents are SSA employees and contractors seeking medical parking permits and their physicians. Because SSA employees are Federal workers exempt from the requirements of the Paperwork Reduction Act, the burden below is only for SSA contractors and physicians (of both SSA employees and contractors).

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Authorizing Statute(s): PL: Pub.L. 106 - 580 Sec. 205(c) Name of Law: The Federal Property and Administrative Services Act of 1949
   US Code: 40 USC 486(c) Name of Law: Management and Disposal of Government Property
  

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 30774	05/26/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 48475	07/31/2026
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Application and Statement (Contractor Applicant)- SSA-3192	SSA-3192 (Contractor Applicant)	Application and Statement
SSA-3193 (Contractor Applicant)	SSA-3193	SSA-3193 (Contractor Applicant)
SSA-3193 (Physician)	SSA-3193 (Physician)	Renewal Certification

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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	623	937	0	302	-616	0
Annual Time Burden (Hours)	497	900	0	686	-1,089	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: When we cleared this ICR in 2023, the burden was 900 hours. However, we are currently reporting a burden of 497 hours. The decrease in burden is due to the decrease in responses from 937 to 623. The significant reason for the decrease in responses is the elimination of Form SSA-3194 from the Information Collection. We removed Form SSA-3194 from our information collection because it is no longer needed; fewer than 10 respondents per year fail to recover within the expected duration provided by the physician, eliminating the need for renewal. This change has significantly reduced completion time and the resulting burden. These figures reflect current Management Information data.

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Annual Cost to Federal Government: $23,610

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: 07/31/2026

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