A. Justification
Introduction/Authoring Laws and Regulations
Sections 205(a), 223(d)(5)(A), 1631(d)(1), and 1631(e)(1) of the Social Security Act (Act) require claimants for Social Security disability benefits to provide medical and other evidence of their disability. These sections of the Act grant the Social Security Administration (SSA) the authority to establish procedures for collecting and verifying this evidence. 20 CFR 404.1512 and 20 CFR 416.912 of the Code of Federal Regulations provide detailed requirements for the types of evidence Social Security disability claimants and beneficiaries must provide showing how their impairment(s) affects their ability to work (e.g., evidence of age, education and training, work experience, daily activities, efforts to work, and any other evidence).
Description of Collection
Individuals receiving or applying for Social Security Disability Insurance, or Supplemental Security Income provide SSA with medical evidence and other proof SSA requires to prove their disability. Past employers familiar with the claimant’s ability to perform work activates complete Form SSA-3385-BK, Report of Adult Functioning-Employer, to provide SSA with information about the employee’s day-to-day function in the working setting. SSA and Disability Determination Services (DDS) use the information Form SSA-3385-BK collects as a basis to determine eligibility or continued eligibility for disability benefits. The respondents are claimants’ past employers.
Use of Information Technology to Collect the Information
The DDS mails Form SSA-3385-BK to the respondent to complete and mail back. SSA did not create an electronic version of Form SSA-3385-BK under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 3,900 respondents complete the form annually. This is less than the GPEA cut-off of 50,000.
Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we
collect it preclude duplication. SSA does not use another collection instrument to obtain similar data.
Minimizing Burden on Small Respondents
This collection does not significantly affect small businesses or other small entities.
6. Consequence of Not Collecting Information or Collecting it Less Frequently If we did not use Form SSA-3385-BK we would be unable to fulfill our mandate to make payments to those that are disabled. There are no technical or legal obstacles to burden reduction.
7. Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on April 27, 2016, at 81 FR 24927, and we received no public comments. The 30-day FRN published on July 5, 2016 at 81 FR 43691. If we receive any comments in response to this Notice, we will forward them to OMB. We did not consult with the public in the development of this form.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Modality of Completion |
Number of Responses |
Frequency of response |
Average burden per response (minutes) |
Estimated Total Annual Burden (hours) |
SSA-3385-BK |
3,900 |
1 |
20 |
1,300 |
The total represents burden hours, and we did not calculate a separate cost burden.
13. Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden to the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $8,644.00. This estimate is a projection of the costs for printing and distributing the collection instrument, and for collecting the information.
15. Program Changes or Adjustments to the Information Collection Request
This new form increases the public reporting burden. See question #12 above for burden figures.
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
17. Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/msword |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| Last Modified By | 889123 |
| File Modified | 2016-07-19 |
| File Created | 2016-07-19 |