Addendum

ADDENDUM TO SUPPORTING STATEMENT FOR INFORMATION COLLECTIONS CONDUCTED BY STATE DISABILITY DETERMINATION SERVICES ON BEHALF OF SSA—SYMPTOMS

OMB # 0960-0555

Revision to the Information Collections

We are adding back into this information collections DDS collection of information about pain or other symptoms using their own forms. This is because we are rescinding implementation of the revised SSA-3373 (Function Report-Adult) (0960-0681) and

SSA-3380 (Function Report-Adult-Third Party) (0960-0635) that OMB had approved on October 10/17/06 that had included symptoms questions. We are temporarily going back to use of the prior editions of the SSA-3373 and SSA-3380 for the reasons explained below. That action affects one previous segment of Information Collection 0960-0555.

There are no changes to the CE and MER segments of Information Collection 0960-0555.

Symptoms Questions

As explained in the Addenda to the Supporting Statements requesting reinstatement of the previous versions of the SSA-3373 and SSA-3380, we are going to do usability testing on revisions of these forms. Our request to reinstate the previous versions of the SSA-3373 and SSA-3380 means that we are removing the symptoms questions that were included in those revised forms OMB approved on 10/17/06. This action must be taken because the previous versions of the SSA-3373 and SSA-3380 that we are asking to be temporarily reinstated did not collect any information about symptoms. We had incorporated symptoms questions into the revised forms to eliminate the need for DDSs to use their own forms to collect this information. Therefore, to collect symptoms information while we work on developing and testing better revised forms, the DDSs must temporarily return to using their own symptoms forms to collect this information under this Information Collections Conducted by State Disability Determination Services on Behalf of SSA (0960-0555), as they had been doing prior to OMB’s approval of the revised SSA-3373 and SSA-3380. We fully intend that the revised forms that we are going to work on and test will include symptoms questions. Upon eventual OMB approval of these revised forms, we will once again be able to eliminate DDS collection of symptoms information under this information collection using their own forms.