Medical Parking Application, 42 CFR 101.20-104.2

Forms and Documents

Document Name	Status
Form SSA-3192 Medical Parking Application, 41 CFR 101.20-104.2 Form and Instruction	Modified
supporting statement.doc Supporting Statement A	2007-06-06
PRA Generic.doc Supplementary Document	2007-03-15

IC Document Collections

IC ID	Document Title	Status
9641	Medical Parking Application, 41 CFR 101.20-104.2 Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0624	ICR Reference No: 200612-0960-002
Status: Historical Active	Previous ICR Reference No: 200403-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Medical Parking Application, 42 CFR 101.20-104.2
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/06/2007
	Date Received in OIRA: 03/27/2007
Terms of Clearance: OMB approves this collection consistent with the revised supporting statement submitted by SSA on 6/6/07.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2010	36 Months From Approved	06/30/2007
Responses	144	0	144
Time Burden (Hours)	144	0	144
Cost Burden (Dollars)	0	0	0

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Abstract: SSA employees with medical disabilities that significantly impact their ability to walk are eligible to apply for special parking privileges. Form SSA-3192 collects information documenting evidence substantiating these employees' disabilities, including physician office notes, X-ray results, MRI exams, pulmonary function tests, or medical test results. This information is then used by an SSA Public Health Physician to determine eligibility for medical parking. Respondents are physicians of SSA employees applying for medical parking.

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Authorizing Statute(s): US Code: 40 USC 486(c) Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 357	01/04/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 12244	03/15/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Medical Parking Application, 41 CFR 101.20-104.2	SSA-3192	Medical Parking Application

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ICR Summary of Burden

	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	144	144	0	0	0	0
Annual Time Burden (Hours)	144	144	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is no change in the burden. We inadvertently gave you the total number of respondent/burden hours for medical parking applications. The policy office believes that they needed to provide the total number of applications on file, and not those completed in a 12-month period. Therefore we are correcting the estimated number of respondents from 800 to 144 and the burden hours from 800 to 144. We do not keep management information on how many of the forms are completed in a 1-year period. However, we believe the estimate is a good estimate and the number of new applicants does not vary much from year to year.

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Annual Cost to Federal Government: $103,620

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/27/2007

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