Supplemental Justification for Revised Collection Instrument

Supplemental Justification for Revised Collection Instrument

SSA-3441 Disability Report--Appeal

0960-0144

20 CFR 404.1512 & 416.912 and 20 CFR, 404.916(c) & 416.1416(c)

Re: Update Screen to Internet Application

Per our correspondent of August 9, 2006, SSA is submitting the revised collection screen to update and align the internet version of the above referenced application with the currently approved hardcopy form. The reason for this change is that SSA recently eliminated the signature requirement from this collection and revised the hardcopy forms to ask for the name, address, and email address of the person completing the report. SSA did not update the Internet version at the time the hardcopy was revised, but is now requesting to include it in the next scheduled update of the internet i3441 application in November.

Attached to this request is the current Review and Send collection screen used in the i3441 application and a mock-up of the proposed screen with the questions about the Person Completing the Report. There are no other material changes to the Internet collection.

Background emails

From: Potter, Rachel F. [mailto:Rachel_F._Potter@omb.eop.gov]
Sent: Wednesday, August 09, 2006 10:06 AM
To: Hartson, Craig
Cc: Lipsky, Faye; c-hartson
Subject: RE: Adding fields to the Internet disability reports

OMB concurs with Craig's suggested approach.  Please submit an 83-C to add the paper-approved data elements to the internet form.  New data elements will be added in the next clearance cycle.

From: Hartson, Craig [mailto:Craig.Hartson@ssa.gov]
Sent: Tuesday, August 08, 2006 5:23 PM
To: Potter, Rachel F.
Cc: Lipsky, Faye; c-hartson
Subject: FW: Adding fields to the Internet disability reports

Rachel,

Please see the below message.  Since the first part of the request is approval on the hardcopy collection we would like to add the name, address, and email address of the person completing the Internet version of the report via a change sheet.   My original call on this was that they would have to complete the regular clearance process, but in talking with the component they are willing to wait to add the relationship and phone number questions, which have not been approval in either collection format, until the next clearance cycle.  That being said, I believe we can make a case for aligning both the Internet and hardcopy collection methods of the SSA-3368 and SSA-3441 for the November release of the application.  

I’ll be out of the office for the rest of the week starting tomorrow, so please also respond to Faye on this one.

THANKS!

Craig Hartson 410-966-3268
Social Security Administration
Center for Publications Management
Reports Clearance Team
craig.hartson@ssa.gov

_____________________________________________
From: Newton, Lynn
Sent: Tuesday, August 08, 2006 10:49 AM
To: Hartson, Craig
Subject: Adding fields to the Internet disability reports

Good morning Craig,

I have a question about information we want to collect on the Internet 3368 and 3441.  When the signature requirement was eliminated on the paper SSA-3368 and SSA-3441 the forms were revised to ask for the name, address, and email address of the person completing the report.  The Internet screens do not collect this information, but we would like to add them in a release scheduled for November.

We would also like to ask for the relationship of the report completer to the claimant and their telephone number.  This information is not collected on the paper forms.  Would these changes require OMB approval? 

Thanks for your assistance.

Lynn Newton

OAS/DESD/Internet Team

410-965-7379

202301