OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Disability Case Development Information Collections

OMB 0960-0555 · SSA.

OMB 0960-0555

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.

The latest form for Disability Case Development Information Collections expires 2029-08-31 and is listed under ICR 202604-0960-004.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Sample CE FormsForm and Instruction
Addendum 0960-0555 (FINAL).docx (document unavailable)Supplementary Document
Public comments from the National Coalition of Social Security and Supplemental Security Income Advocates.pdf (document unavailable)Public Comments
Public Comments from Eleven Advocacy Groups (including NOSSCR and Community Legal Services of Philadelphia).pdf (document unavailable)Public Comments
Addendum - 0555 (Final).docx (document unavailable)Supplementary Document
Addendum 0960-0555.docxSupplementary Document
Supporting Statement 0960-0555 (FINAL).docxSupporting Statement A
Category I , CE a) Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category) Other-Samples of DDS CE Forms
Category III - Pain/Other Symptoms/Impairment Information - Request for Third Party Other-Request for Third Party Contact
Category III - Pain/Other Symptoms/Impairment Information - Headache Questionnaire - Adult Other-Headache Questionnaire (CLMT)
Category III - Pain/Other Symptoms/Impairment Information - Seizure Witness Questionnaire – Adult Other-Seizure Witness Questionnaire (3RD PTY)
Category I, CE f) Text and Email CE Reminder Call Script/Letter Other-DCPS Scheduling Text and Email Consent Script
d) Travel time to and completion of CE Other-Credentialing
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 .
Category III - Pain/Other Symptoms/Impairment Information - Seizure Questionnaire - Adult Other-Seizure Questionnaire
Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms") Form and Instruction
Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms") Form and Instruction
Category II - MER, ERE & Connect Direct transmission of MER forms (subset of "MER Samples" category) Other-ERE Transmission of "MER Samples" Category
Category II - MER Paper Submissions (subset of "MER Samples") category Other-Sample of MER forms
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
Category I, CE b) Claimant/Appointment Letter Information (subset of "CE Forms Samples" category) Other-CE Appointment Notice to Claimant (Adult)
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

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202604-0960-004 Revision of a currently approved collection 2026-04-29
202412-0960-005 No material or nonsubstantive change to a currently approved collection 2024-12-12
202402-0960-002 No material or nonsubstantive change to a currently approved collection 2024-02-14 Approved without change
202008-0960-021 Revision of a currently approved collection 2020-12-09
202008-0960-015 No material or nonsubstantive change to a currently approved collection 2020-08-07 Approved without change
202004-0960-001 No material or nonsubstantive change to a currently approved collection 2020-04-02 Approved without change
201703-0960-008 Revision of a currently approved collection 2017-07-11 Approved without change
201604-0960-013 No material or nonsubstantive change to a currently approved collection 2016-04-20 Approved without change
201404-0960-006 Extension without change of a currently approved collection 2014-08-08 Approved without change
201201-0960-001 No material or nonsubstantive change to a currently approved collection 2012-01-17 Approved without change
201103-0960-011 Revision of a currently approved collection 2011-07-28 Approved without change
200708-0960-016 Revision of a currently approved collection 2008-05-30 Approved without change
200703-0960-002 Revision of a currently approved collection 2007-03-19 Approved without change
200402-0960-008 Revision of a currently approved collection 2004-02-23 Approved without change
200205-0960-002 Extension without change of a currently approved collection 2002-05-01 Approved without change
200109-0960-026 No material or nonsubstantive change to a currently approved collection 2001-09-28 Approved without change
199812-0960-004 Revision of a currently approved collection 1998-12-07 Approved without change
199509-0960-003 No material or nonsubstantive change to a currently approved collection 1995-09-19 Approved with change
199507-0960-001 New collection (Request for a new OMB Control Number) 1995-07-21 Approved without change

OMB Details

Category I , CE a) Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category)

Federal Enterprise Architecture: Income Security - General Retirement and Disability