Authorization to Disclose Information to the Social Security Administration

Forms and Documents

Document Name	Status
Form SSA-827 Authorization to Disclose Information to the Social Security Administration / SSA-827 Form and Instruction	Modified
Form SSA-827 Authorization To Disclose Information To The Social Security Administration / SSA-827 (sign and date only) Form	Modified
SSA-827.pdf Supplementary Document	2008-09-18
Addendum--0623.doc Supplementary Document	2008-09-19
Supporting Statement--0623.doc Supporting Statement A	2008-09-19

IC Document Collections

IC ID	Document Title	Status
9639	Authorization to Disclose Information to the Social Security Administration / SSA-827 Form and Instruction	Modified
183732	Authorization to Disclose Information to the Social Security Administration (Internet Instructions) Instruction	Modified
179551	Authorization To Disclose Information To The Social Security Administration / SSA-827 (sign and date only) Form	Modified

ICR Details

OMB Control No: 0960-0623	ICR Reference No: 200806-0960-010
Status: Historical Active	Previous ICR Reference No: 200712-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Authorization to Disclose Information to the Social Security Administration
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/26/2008
	Date Received in OIRA: 10/10/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2011	36 Months From Approved	04/30/2011
Responses	16,001,944	0	16,001,944
Time Burden (Hours)	864,329	0	864,329
Cost Burden (Dollars)	0	0	0

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Abstract: 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).

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Authorizing Statute(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
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 40005	07/11/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 53919	09/17/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Authorization To Disclose Information To The Social Security Administration / SSA-827 (sign and date only)	SSA-827	Authorization to Disclose Information to the Social Security Administration
Authorization to Disclose Information to the Social Security Administration / SSA-827	SSA-827	Authorization To Disclose Information To The Social Security Administration
Authorization to Disclose Information to the Social Security Administration (Internet Instructions)

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ICR Summary of Burden

	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	16,001,944	16,001,944	0	0	0	0
Annual Time Burden (Hours)	864,329	864,329	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $23,740,196

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/10/2008

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