Addendum to the Supporting Statement 0960-0555

Addendum 0960-0555.doc

Clearance of Information Collections Conducted by State Disability Determination Services on Behalf of SSA

Addendum to the Supporting Statement 0960-0555

OMB: 0960-0555

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Addendum to the

Supporting Statement for

Clearance of Information Collections Conducted by

State Disability Determination Services on behalf of

the Social Security Administration


20 CFR, Subpart P, 404.1503a, 404.1512, 404.1513, 404.1514 404.1517, 404.1519; 20 CFR Subpart Q, 404.1613, 404.1614, 404.1624; 20 CFR Subpart I, 416.903a, 416.912, 416.913, 416.914, 416.917, 416.919 and 20 CFR Subpart J, 416.1013, 416.1024,


OMB No. 0960-0555

Revisions to the Collection Instrument


  • Under medical evidence of record (MER), we added a collection instrument to gather information from treating sources (e.g., treating source questionnaires). This action increased respondents’ overall response times by 5 minutes per method of response (electronic/paper).


  • We have expanded the category of the information collection instrument under pain/other symptoms to include impairments, and collecting information on specific impairments.


  • These additions more accurately reflect the public reporting burden.


  • We combined the two electronic reporting methods into one information collection instrument.


  • We decreased the response times under the information collection instrument for consultative examinations (CE) a.) medical evidence as a result of respondents becoming more familiar, thus quicker, with electronic submissions.


SSA is also making the following revisions:


We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.


SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the first page of the form.

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified By889123
File Modified2011-06-03
File Created2011-05-03

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