Authorization to Source to Release Information to the Social Security Administration

ICR 200704-0960-007

OMB: 0960-0623

Federal Form Document

Forms and Documents
ICR Details
0960-0623 200704-0960-007
Historical Active 200404-0960-008
SSA
Authorization to Source to Release Information to the Social Security Administration
Revision of a currently approved collection   No
Regular
Approved without change 06/06/2007
Retrieve Notice of Action (NOA) 04/11/2007
OMB approves this collection consistent with the e-mail sent by SSA on 6/5/07.
  Inventory as of this Action Requested Previously Approved
06/30/2010 36 Months From Approved 06/30/2007
15,415,712 0 15,415,712
835,017 0 2,569,285
0 0 0

SSA must obtain sufficient medical evidence to make eligibility determinations for title II and title XVI payments. Therefore, the applicant must authorize their medical source(s) to release the information to SSA. The applicant may use form SSA-827 to provide consent for the release of information. Generally, the State DDS completes the form(s) based on information provided by the applicant, and sends the form(s) to the designated medical source(s).

US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 1383 Name of Law: null
   US Code: 42 USC 423 Name of Law: null
   US Code: 42 USC 1382c Name of Law: null
  
None

Not associated with rulemaking

  72 FR 3468 01/25/2007
72 FR 14845 03/29/2007
No

  Total Approved 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 15,415,712 15,415,712 0 0 0 0
Annual Time Burden (Hours) 835,017 2,569,285 0 0 -1,734,268 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The reduction in the public reporting burden is due to a change in the IC burden calculation. Please see the ICR Addendum for a complete explanation.

$23,740,196
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/11/2007


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