Medical Source Statement of Ability to Do Work-Related Activities

ICR 201406-0960-011

OMB: 0960-0662

Federal Form Document

ICR Details
0960-0662 201406-0960-011
Historical Active 201109-0960-011
SSA
Medical Source Statement of Ability to Do Work-Related Activities
Revision of a currently approved collection   No
Regular
Approved without change 10/24/2014
Retrieve Notice of Action (NOA) 09/24/2014
  Inventory as of this Action Requested Previously Approved
10/31/2017 36 Months From Approved 02/28/2015
300,000 0 240,000
75,000 0 60,000
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

  79 FR 38107 07/03/2014
79 FR 56428 09/19/2014
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 300,000 240,000 0 0 60,000 0
Annual Time Burden (Hours) 75,000 60,000 0 0 15,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There has been an increase in burden hours. The change stems from an increase in the number of cases being processed by the hearing offices yearly, causing an increase in the request for information and an increase in the burden hours.

$9,000
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.
09/24/2014


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