Medical Source Statement of Ability to Do Work-Related Activities

ICR 201109-0960-011

OMB: 0960-0662

Federal Form Document

ICR Details
0960-0662 201109-0960-011
Historical Active 200810-0960-004
SSA
Medical Source Statement of Ability to Do Work-Related Activities
Revision of a currently approved collection   No
Regular
Approved without change 02/13/2012
Retrieve Notice of Action (NOA) 01/13/2012
  Inventory as of this Action Requested Previously Approved
02/28/2015 36 Months From Approved 05/31/2012
240,000 0 200,000
60,000 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: Social Security Act
   US Code: 42 USC 1381 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  76 FR 68805 11/07/2011
77 FR 147 01/03/2012
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 240,000 200,000 0 0 40,000 0
Annual Time Burden (Hours) 60,000 50,000 0 0 10,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The increase in burden is due to an increase in the frequency of response per respondent. Previously we stated that the medical sources responded approximately 20 times per year; however, we noticed an increase in that number.

$7,200
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.
01/13/2012


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