Disability Case Development Information Collections

OMB 0960-0555

State disability determinations services collect the information SSA needs to administer our disability program. For the purposes of this ICR, we divide this information into three categories: 1) consultative examinations (a/b/c); 2) medical evidence of record; and 3) pain/other symptoms/impairment. Respondents are individuals, private sector, and State and local governments. We are submitting a non-substantive Change Request to request a new notice for use for CE video teleconferences specifically for the current COVID-19 emergency. The new notice will mirror our current call script which OMB approved on 4/30/20.

The latest form for Disability Case Development Information Collections expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form Pain Questionnaire Category III - Pain/Other Symptoms/Impairment Information Form
Form Pain Questionnaire Category III - Pain/Other Symptoms/Impairment Information Form
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
Justification for Non-Substantive Changes - 0960-0555.docx Justification for No Material/Nonsubstantive Change
Justification for Non-Substantive Changes - 0960-0555.docx Justification for No Material/Nonsubstantive Change
Supporting Statement - 0555 (Clean Copy).docx Supporting Statement A
Supporting Statement - 0555 (Clean Copy).docx Supporting 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 I, CE d) One-Time CE Claimant Telehealth Call Script (subset of "CE Forms Samples" category) Other- THCE Agreeement Call Script - Adult (revised).
Category III - Pain/Other Symptoms/Impairment Information Form
Category III - Pain/Other Symptoms/Impairment Information Form
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-Sample of Appointment Letter Included
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

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

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