Function Report - Adult Third Party

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-3380 Function Report -- Adult Third Party	Form and Instruction	Modified	Available
Addendum - 0635.docx	Supplementary Document	Uploaded 2026-09-15	Available
Supporting Statement - 0635 (Final).docx	Supporting Statement A	Uploaded 2026-09-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9663	Function Report - Adult Third Party	Form and Instruction	Modified	Function Report -- Adult Third Party
9663	Function Report - Adult Third Party	Other-Privacy Act Statement Revised	Modified

ICR Details

OMB Control No: 0960-0635	ICR Reference No: 202608-0960-010
Status: Received in OIRA	Previous ICR Reference No: 202110-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Function Report - Adult Third Party
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/24/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2026
Responses	635,620	709,700
Time Burden (Hours)	699,182	721,528
Cost Burden (Dollars)	0	0

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Abstract: Individuals receiving or applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) provide SSA with medical evidence and other proof SSA requires to prove their disability. SSA, and Disability Determination Services (DDS) on our behalf, collect this information using Form SSA-3380-BK. We use the information to document how claimant's disabilities affect their ability to function, and to determine eligibility for SSI and SSDI claims. The respondents are third parties familiar with the functional limitations (or lack thereof) of claimants who apply for SSI and SSDI benefits.

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Authorizing Statute(s): US Code: 42 USC 423 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 48470	07/31/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 60677	09/24/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Function Report - Adult Third Party	SSA-3380	Function Report -- Adult Third Party

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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	635,620	709,700	0	0	-74,080	0
Annual Time Burden (Hours)	699,182	721,528	0	0	-22,346	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 721,528 hours. However, we are currently reporting a burden of 646,214 hours. This change stems from a decrease in the number of responses and an increase in burden time per response. Responses decreased from 709,700 to 635,620. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. In addition, the burden time increased by five minutes per response due to learning costs that we did not include in our last theoretical burden calculation. *Note: The total burden reflected in ROCIS is 6,99,182, while the burden cited in #12 of the Supporting Statement is 646,214. This discrepancy is because the ROCIS burden reflects the learning costs. In contrast, the chart in #12 above reflects actual burden.

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Annual Cost to Federal Government: $7,687,765

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: 09/24/2026

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