Title of Information Collection and Form Number(s)

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Supporting Statement for Forms SSA-3192 and SSA-3193
Medical Permit Parking Application Forms
41 cfr 102-74.305
OMB No. 0960-0624

A. 	Justification

    1. Introduction/Authoring Laws and Regulations
As Per Sections 41 CFR 102-74.305 of the Code of Federal Regulations, Social Security Administration (SSA) employees and contractors with qualifying medical conditions who park at SSA-owned and leased facilities may apply for an SSA medical parking permit.

    2. Description of Collection
SSA employees and contractors with a qualifying medical condition who park at SSA‑owned and leased facilities may apply for, and receive, a medical parking permit.  SSA uses two forms for the medical permit parking program:  (1) SSA‑3192, the Application and Statement, which individuals complete when they first apply for a medical parking space; and (2) SSA-3193, the Physician’s Report, which the applicant’s physician completes to verify the medical condition.  
Employees seeking information about medical parking at SSA Headquarters visit the Security and Resiliency website and review the “How do I obtain medical parking hangtag?” section.  Employees at SSA’s Main Complex contact the Parking and Credentialing Office by phone at (410) 965‑5910 or by email at [email protected] for assistance.  Employees find parking procedures for SSA Headquarters properties in the Baltimore Metropolitan area in the Administrative Instructions Manual System on the Social Security Administration website.
Employees apply for a medical parking permit by completing the information collection activity in one of several ways:

    • Electronic Submission:  Employees use the Reasonable Accommodation Wizard to submit their request online.

    • Written Submission:  Employees complete the Request for Reasonable Accommodation (Form SSA-3192) or the Physician Report Form (SSA-3193).  Employees complete Section A of Form SSA-3193 to authorize their treating physician to release medical information.  Physicians complete the medical parking application and fax the form using the instructions on SSA-3193.  Employees may also use the Parking Management module at https://safeopss.ba.ssa.gov/parking to upload their state medical placard/hangtag and state disability certification.

    • Verbal or Written Request:  Employees submit their request verbally or in writing (including email or in-person) to their supervisor, the Reasonable Accommodation Coordinator, the Center for Accommodations and Disability Services, or the Office of Security Administration and Project Management.

We identified the following psychological costs based on the requirements for this information collection:

Psychological Cost:
    • Requirement for the Program:  The agency asks individuals applying for a medical
parking permit questions related to their medical condition.

    • Psychological Cost:  SSA employees and contractors who respond may perceive these questions as personal, may feel uncomfortable sharing this information, and may worry that their response could cause a delay in receiving the medical permit.  As a result, individuals may choose to delay or abandon completing the form.

We understand these psychological costs may cause respondents to delay their completion of the information collection or cause them to abandon the information collection entirely.  However, we require full completion of this information collection to receive benefits.  Therefore, we have taken this potential psychological cost into account when calculating our burden in #12 below.

The respondents are SSA employees and contractors seeking medical parking permits and their physicians.

    3. Use of Information Technology to Collect the Information
Under the Agency’s Government Paperwork Elimination Act plan, we created electronic versions of Forms SSA-3192 (Request for Reasonable Accommodation for employees to complete), and SSA-3193 (the Physician’s Report Form) using the Reasonable Accommodation Wizard.  In addition, on April 15, 2016, we added an electronic application and renewal process to our Parking Management Module (PMM), in the Security Automated Features and Enhancements (SAFE) web portal, located at: https://safeopss.ba.ssa.gov/parking.  We still utilize paper forms for employees and contractors that do not have access to SSANet.  Approximately 85 percent of employees and contractors who complete a medical parking application do so online.

    4. Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it precludes duplication.  SSA does not use another collection instrument to obtain similar data.  

    5. Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities. 

    6. Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Forms SSA-3192 and SSA-3193, we would be unable to uniformly assign medical parking permits for qualifying SSA employees or contractors.  Because we collect the information on an as needed basis, we cannot collect it less frequently.  There are no technical or legal obstacles to burden reduction.


    7. Special Circumstances 
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.

    8. Solicitation of Public Comment and Other Consultations with the Public 
The 60-day advance Federal Register Notice published on May 26, 2026, at 91 FR 30774, and we received no public comments.  The 30-day FRN published on July 31, 2026, at 91 FR 48475.  If we receive any comments in response to this Notice, we will forward them to OMB.  We did not consult with the public in the development revision of this form.

    9. Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents. 

    10. Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.

    11. Justification for Sensitive Questions
As stated in #2 above, SSA requires the respondents for these forms to provide medical information one could consider as sensitive, As such, this information collection may have  psychological costs pertaining to collection of personal questions (which we also discussed in #2 above).  However, SSA needs this information to determine if the applicant qualifies for a medical parking permit, and we do not share the information with anyone outside of the SSA contracted physician who makes the eligibility determination.

    12. Estimates of Public Reporting Burden
Please see the burden chart below:
	
Method
of Completion
Number 
of Respondents
Frequency
of 
Response
Average Burden Per Response (minutes)
Estimated Total Annual Burden (hours) 
Average Theoretical Cost Amount (dollars)*
Total Annual Opportunity Cost (dollars) ***
SSA-3192
(Contractor Applicant)
195
1
30
98
$ 55.15*
$5,405**
SSA-3193
(Contractor Applicant)
195

1
15++
49
$55.15*
$2,702**
SSA-3193
(Physician)
233+
1
90
350
$133.30*
$46,655**
Totals
623


497

$54,762**
+ This figure accounts for all of the forms the physicians complete (both from SSA employees and contractors).

++ This average figure includes both the time estimate for the contractor applicant completing the top portion of Form SSA-3193 (approximately 5 minutes) and the amount of time to bring the form to the physician (approximately 10 minutes).

* We based these figures on the average SSA contractor’s hourly wages based on SSA’s management information, and the average Physician’s hourly wages, as reported by Bureau of Labor Statistics data (Occupational Employment and Wage Statistics).

** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application.  There is no actual charge to respondents to complete the application.

We did not include travel time as per our current management information data, respondents who complete this form can submit it electronically or provide a written or verbal request.  There is a possible indirect travel burden to applicants if they bring the completed form to the physician’s office; however, we already accounted for the travel time of 10 minutes to bring the form to the physician’s office in the chart above (as per our mention of that time under the chart above).

We did not include a separate Learning Cost for this information collection, as we include the Learning Cost in the burdens listed in the chart above.

We base our burden estimates on current management information data, which includes data from actual interviews, as well as from years of conducting this information collection.  Per our management information data, we believe that 15, 30, and 90 minutes accurately shows the average burden per response for reading and understanding instructions; gathering the data and documents needed; answering the questions and completing the information collection instrument; and scheduling any necessary appointment or required phone call.  Based on our current management information data, the current burden information we provided is accurate.  The total burden for this ICR is 497 burden hours (reflecting SSA management information data), which results in an associated theoretical (not actual) opportunity cost financial burden of $53,929.  SSA does not charge respondents to complete our applications.

13. 	Annual Cost to the Respondents (Other) 
This collection does not impose a known cost burden on the respondents.   

    14. Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $23,610.  This estimate accounts for costs from the following areas:


Description of Cost Factor
Methodology for Estimating Cost
Cost in Dollars*
Designing and Printing the Form
Design Cost + Printing Cost
$1,500
Distribution, Shipping, and Material Costs for the Form
Distribution + Shipping + Material Cost
$0*
SSA Employee (e.g., field office, 800 number, DDS staff) Information Collection and Processing Time
GS-11 employee x# of responses x processing time 
$18,690
Full-Time Equivalent Costs
Out of pocket costs + Other expenses for providing this service
$0*
Systems Development, Updating, and Maintenance
GS-9 employee x man hours for development, updating, maintenance
$3,420*
Quantifiable IT Costs
Any additional IT costs
$0*
Total

$23,610*
* We have inserted a $0 amount for cost factors that do not apply to this collection.

SSA is unable to break down the costs to the Federal government further than we already have.  It is difficult for us to break down the cost for processing a single form, as our staff at SSA Headquarters processes these and several forms.  Also, because so many employees have a hand in each aspect of our forms, we use an estimated average hourly wage, based on the wage of our average staff employee (GS-11) for these calculations.  However, we have calculated these costs as accurately as possible based on the information we collect for creating, updating, and maintaining these information collections.

15.	Program Changes or Adjustments to the Information Collection Request
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.

16.  	Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.



17.	Displaying the OMB Approval Expiration Date
For the paper forms SSA-3192 and SSA-3193, we will not publish the OMB approval expiration date.  OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms.   SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval.  Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste. 

For the Internet version of forms SSA-3192 and SSA 3193, SSA is not requesting an exception to the requirement to display the OMB approval expiration date.

    18. Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

B.     	Collections of Information Employing Statistical Methods

	SSA does not use statistical methods for this information collection.