Report on Individual with Mental Impairment

ICR 201107-0960-005

OMB: 0960-0058

Federal Form Document

Forms and Documents
ICR Details
0960-0058 201107-0960-005
Historical Active 200808-0960-002
SSA
Report on Individual with Mental Impairment
Revision of a currently approved collection   No
Regular
Approved without change 12/12/2011
Retrieve Notice of Action (NOA) 11/10/2011
  Inventory as of this Action Requested Previously Approved
12/31/2014 36 Months From Approved 02/29/2012
500 0 50,000
300 0 30,000
0 0 0

SSA uses the SSA-824 to obtain medical evidence from medical sources that have treated the claimant for a mental impairment. SSA uses the information collected on this form to establish whether a claimant filing for disability benefits has a mental impairment that meets the statutory definition of disability under the Social Security Act. The respondents are mental treatment sources or facilities.

US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 1382c Name of Law: Social Security Act
  
None

Not associated with rulemaking

  76 FR 45902 08/01/2011
76 FR 68805 11/07/2011
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 500 50,000 0 0 -49,500 0
Annual Time Burden (Hours) 300 30,000 0 0 -29,700 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Since last we cleared this information collection, the DDS offices have changed their business processes for acquiring this information. They have found it more cost effective to use the medical evidence of record process as outlined in the OMB-approved information collection OMB No. 0960-0555, Clearance of Information Collections Conducted by State Disability Determination Services on Behalf of the Social Security Administration.

$7,500
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@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.
11/10/2011


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