Addendum to the Supporting Statement 0960-0292

Addendum to the Supporting Statement for Form HA-4631

Claimant's Recent Medical Treatment

20 CFR 404.1512 and 416.912

OMB No. 0960-0292

Section A: Public Comments

We published the 60-day advance Federal Register Notice on April 6, 2021 at 86 FR 1787, and we received the following comments from the National Organization of Social Security Claimants’ Representatives (NOSSCR)

• Comment #1:

NOSSCR recommends SSA moves the current question #3 above questions #1 and #2, first asking about hospitalizations and then about other treatment by doctors and other medical providers. NOSSCR states since people are generally treated by doctors in a hospital, respondents can be confused by the current order of questions and list treatment by a doctor in a hospital in question 1.

• SSA Response #1: SSA appreciates your comment, but at this time, we will not incorporate the changes during this clearance. However, we will take your recommendations into consideration in the future. The HA-4631 comes later in a line of forms (including form HA-3368, the Initial Disability Report) that the claimant receives to provide information on their impairments, treatments, and their effects on the ability to work. The HA-4631 seeks to update this prior information to ensure all relevant treatment records are considered by the Judge. In a future update to Form HA-4631, SSA plans to revamp this form so the order and type of medical information requested, as well as the terminology used, matches form HA-3368. This consistency will improve clarity and efficiency.

SSA notes the current version of question #1 on this form specifically requests for treatment “by a doctor (other than a doctor at a hospital).” SSA thinks this question is clear in requesting only treatment by doctor’s outside of hospital visits and that question #3 provides respondents an opportunity to add information about hospital treatment.

Question #3 is meant to be broad and inclusive in order to capture all types of admissions to a hospital. It also provides space for the respondent to add further detail on the type or length of admission, if necessary.

• Comment #2:

NOSSCR recommends Form HA-4631 clarify what is meant by “have you been hospitalized” in current question 3: does hospitalization require admission or an overnight stay (in which case, where should emergency room visits and outpatient treatment be listed?) or does it include all treatment that occurs in a hospital

• SSA Response #2: SSA plans to revamp Form HA-4631 in the future, so the order and type of medical information requested, as well as the terminology used, matches Form HA-3368. Form HA-3368 provides entries to distinguish between types of hospital admissions.

• Comment #3:

NOSSCR recommends Form HA-4631 should ask not just for treatment by doctors, but by other acceptable medical sources recognized in SSA’s regulations: certified nurse midwives and certified registered nurse anesthetists; nurse practitioners and clinical nurse specialists (collectively, Advance Practice Registered Nurses); licensed psychologists; optometrists; podiatrists; physicians’ assistants; and audiologists; and qualified speech-language pathologists.

• SSA Response #3:

SSA agrees with this proposed change and plans to update this form to replace “doctors” with “doctors or other health care providers.” Form HA-3368 also uses this terminology. SSA’s regulations (20 CFR 404.1502 and 416.902) list 12 types of acceptable medical sources, and our forms seek to use plain language for ease of use by respondents. Using “doctors or other health care providers,” rather than listing some or all of the acceptable medical sources recognized by our regulations, conveys the variety of medical sources beyond doctors without overburdening the respondent with long, regulatory language.

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

• Change #1: We are revising the Privacy Act Statement on this form.

Justification #1: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.

• Change #2: We removed the Office of Hearings and Appeals from the title bar of the form.

Justification #2: The name of the organization was changed due to a reorganization. We don’t believe the specific organization within SSA is necessary to be included on the form anymore.

• Change #3: We are revising the language in question #1 and the

Current Language: Have you been treated or examined by a doctor (other than a doctor at a hospital) since the above date?

(If yes, please list the name, addresses and telephone numbers of doctors who have treated or examined you since the above date. Also list dates of treatment or examination. If possible, send updated reports from these doctors to the Administrative Law Judge prior to the date of your hearing.)

New Language: Have you been treated or examined by a doctor, or other health care provider, (other than being hospitalized) since the above date. (other than a doctor at a hospital) since the above date?

(If yes, please list the name, addresses and telephone numbers of doctors, or other health care providers, who have treated or examined you since the above date. Also list dates of treatment or examination. If possible, send updated reports from these doctors, or other health care providers, to the judge prior to the date of your hearing.)

Justification #3: We are revising the language, because using “doctors or other health care providers,” rather than listing some or all of the acceptable medical sources recognized by our regulations, conveys the variety of medical sources beyond doctors without overburdening the respondent with long, regulatory language

Change #4. We are revising the language in the chart on question #1.

Current Language: Doctors Name

New Language: NAME(S) OF DOCTOR OR OTHER HEALTH CARE PROVIDER
Justification #4: We are revising the language, because using “doctors or other health care providers,” rather than listing some or all of the acceptable medical sources recognized by our regulations, conveys the variety of medical sources beyond doctors without overburdening the respondent with long, regulatory language.
	Change #5: We are revising the language on question #2. Current Language: What have these doctors told you about your condition? Revised Language: What have these doctors, or other health care providers, told you about your condition?
	Justification #5: We are revising the language, because using “doctors or other health care providers,” rather than listing some or all of the acceptable medical sources recognized by our regulations, conveys the variety of medical sources beyond doctors without overburdening the respondent with long, regulatory language