Medical Source Statement of Ability to Do Work-Related Activities

ICR 200810-0960-004

OMB: 0960-0662

Federal Form Document

ICR Details
0960-0662 200810-0960-004
Historical Active 200608-0960-007
SSA
Medical Source Statement of Ability to Do Work-Related Activities
Extension without change of a currently approved collection   No
Regular
Approved without change 05/04/2009
Retrieve Notice of Action (NOA) 04/03/2009
  Inventory as of this Action Requested Previously Approved
05/31/2012 36 Months From Approved 05/31/2009
200,000 0 200,000
50,000 0 50,000
0 0 0

SSA uses Forms HA-1151 and HA-1152 to collect data that is required to determine the residual functional capacity (RFC) of individuals who are appealing denied claims for benefits based on disability. The RFC of an individual must be determined in cases where SSA cannot make a determination on a claim for benefits based on current work activity or on medical facts alone. The respondents are medical sources paid by SSA to provide reports based either on existing medical evidence or on consultative examinations conducted for the purposes of the report.

US Code: 42 USC 902 Name of Law: null
   US Code: 42 USC 1381 Name of Law: null
  
None

Not associated with rulemaking

  73 FR 63761 10/27/2008
74 FR 7506 02/17/2009
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 200,000 200,000 0 0 0 0
Annual Time Burden (Hours) 50,000 50,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There are no changes in the public reporting burden. However, prior to ROCIS, SSA was unable to show the separate estimates for each form. Because ROCIS now allows us to separate the two forms, we are reporting the burdens per form separately; therefore, the burden estimate is more accurate.

$6,000
No
No
Uncollected
Uncollected
No
Uncollected
John Biles 410 965-3758 John.Biles@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.
04/03/2009


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