Addendum to the Supporting Statement for Form SSA-3462

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Addendum to the Supporting Statement for Form SSA-3371-BK
Pain Report – Child
20 CFR 416.912
OMB No. 0960-0540

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

    • Change #1:  We are revising the PRA statement on this form.

Justification #1:  We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.

    • Change #2:  We are revising the Privacy Act Statement on this form.

Justification #2:  SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms.  As a result, SSA is updating the Privacy Act Statement on the form.

Terms of Clearance
OMB placed the following Terms of Clearance on this Information Collection when they last approved it on 10/23/23:

Term:  Prior to resubmission, the agency will revise Question Prompt #2 of Supporting Statement A to better contextualize the process of collecting and submitting this information consistent with user journey approach described in M-22-10 (Section 1.1).  To that extent the agency will ensure the Supporting Statement A details how a respondent is informed of the need to complete this form, when the information is collected (e.g. whether is it during an existing transaction point in which multiple forms are completed), which forms are completed prior to this information collection that would normally trigger requesting submission of this information collection, and how the information is collected (e.g. oral interviews at a field office vs. written response).

SSA response:  SSA revised Question Prompt #2 of the Supporting Statement A to better contextualize the process of collecting and submitting this information consistent with the user journey approach as described in M-22-10 (Section 1.1)  To that extent SSA ensured the Supporting Statement A details the following: 1) how a respondent is informed of the need to complete the SSA-3371-BK; 20; 2) when SSA collects the information (e.g. whether is it during an existing transaction point in which multiple forms are completed); 3) which forms are completed prior to this information collection that would normally trigger requesting submission of this information collection; and 3) how SSA collects the information (e.g. oral interviews at a field office vs. written response).


Public Comments on the Information Collection
60-Day Comment Period Federal Register Notice (FRN):
The 60-day Comment Period began on August 27,2026, and ended on October 26,2026, at 11:59pm.  We received 1 public comments on the 60-Day Comment Period FRN from the National Coalition of Social Security and Supplemental Security Income Advocates.  We acknowledge and appreciate the thoughtful feedback from the commenters, and we responded to the comments below:

Comment on the Pain Report-Child (SSA-3371-BK)

    • Comment #1:  
The commenter states they have no comments regarding the Pain Report – Child form; however, they state the average burden per response time of 15 minutes seems to short to complete the form.

SSA Response #1:  
The SSA-3371-BK provides disability case reviewers with supplemental information about a child’s pain including information about where the pain is located, how long the pain lasts, how often the pain occurs, what causes the pain, and any medication(s) or treatment(s) used to relieve the pain.  We base our burden estimates on current management information data, which includes data from interviews and years of conducting this information collection.  Base on this data, we estimate that the form takes approximately 15 minutes to complete.  However, we acknowledge that more or less time may be needed contingent on the amount of detail and information the respondent provides and whether the child has pain in more than one part of their body.  As always, we will revisit our burden estimates when we next renew the OMB-approval for this form, or when we next revise this form.