Authorization to Disclose Information to the Social Security Administration

ICR 201209-0960-014

OMB: 0960-0623

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Justification for No Material/Nonsubstantive Change
2012-09-25
ICR Details
0960-0623 201209-0960-014
Historical Active 201202-0960-001
SSA
Authorization to Disclose Information to the Social Security Administration
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/25/2012
Retrieve Notice of Action (NOA) 09/25/2012
  Inventory as of this Action Requested Previously Approved
10/31/2014 10/31/2014 10/31/2014
4,829,651 0 4,829,651
680,164 0 680,164
0 0 0

SSA must obtain sufficient evidence to make eligibility determinations for Title II and Title XVI payments. Therefore, the applicant must authorize release of information from various sources to SSA. The applicant uses the SSA–827 to provide consent for the release of medical records, education records, and other information related to his or her ability to perform tasks. Once the applicant completes the SSA–827, SSA or the State Disability Determination Service sends the form to the designated source(s) to obtain pertinent records. The respondents are applicants for TitleII benefits and Title XVI payments. This Non-Substantive Change Request includes finalized screens for in-person or telephone interview attestation.

US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 1382c Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  76 FR 23640 04/27/2011
76 FR 53703 08/29/2011
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 4,829,651 4,829,651 0 0 0 0
Annual Time Burden (Hours) 680,164 680,164 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$10,386,309
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.
09/25/2012


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