Nonsubstantive Change SSA-3375

Justification for Non-Substantive Changes to Form SSA-3375

Function Report- Child, Birth to 1^st Birthday

20 CFR 416.912

OMB No. 0960-0542

Background

Generally, SSA sends the paper Form SSA-3375 to claimants to collect information about an impairment-related limitations and ability to function. Additionally, SSA provides a PDF version of the SSA-3375 on its website for the public to print, complete, and submit to SSA for processing. At this time, respondents must print the blank PDF and fill it out using pen and ink or a typewriter. As some respondents’ handwriting is difficult to read or illegible, these non-fillable versions of the form are inefficient and ineffective because SSA employees, who cannot read the submitted form, must then re-contact the respondent prior to processing. In addition, the use of typewriters has decreased significantly, as other tools, such as personal computing devices, have increased in use.

SSA developed a fillable, printable version of the SSA-3375, as some respondents may find it easier to use. The fillable version allows the respondents to complete the form electronically using a personal computer or other computing device, print the completed form, and submit it to SSA. SSA developed this fillable version to provide effective communication and this version of the form remains in compliance with the requirements of 45 CFR 85.51 of the Code of Federal Regulations and section 504 of the Rehabilitation Act of 1973. SSA proposes the fillable PDF version as a more accessible modality. In addition, the new fillable modality will enhance SSA’s electronic services and recordkeeping efforts.

Revisions to the Information Collection

Change 1: SSA intends to provide Form SSA-3375 in a fillable PDF file on its website, in place of the non-fillable PDF version it currently provides. SSA proposes to make all form entries fillable.

Justification 1: This change will allow the respondents to continue to print and complete the form by hand or, alternatively, complete the form using a computing device, such as a personal computer or handheld (mobile) device, print, and submit to SSA for processing.

After OMB approves the addition of the new fillable version of the form, SSA will phase out the standard PDF versions from its Internet and Intranet websites and replace them with the fillable PDF file.

This action does not affect the public reporting burden.