Medical or Psychological Consultant's Review of Childhood Disability Evaluation Form (SSA-538)

Forms and Documents

Document Name	Status
Form SSA-536 Medical or Psychological Consultant's Review of Childhood Disability Evaluation Form (SSA-538) Form	Modified
Addendum to Supporting Statement.doc Justification for No Material/Nonsubstantive Change	2009-06-10
SSA-536 Supporting Statement--120908 REVISED.doc Supporting Statement A	2009-04-30

IC Document Collections

IC ID	Document Title	Status
43712	Medical or Psychological Consultant's Review of Childhood Disability Evaluation Form (SSA-538) Form	Modified

ICR Details

OMB Control No: 0960-0675	ICR Reference No: 200812-0960-013
Status: Historical Active	Previous ICR Reference No: 200606-0960-017
Agency/Subagency: SSA	Agency Tracking No:
Title: Medical or Psychological Consultant's Review of Childhood Disability Evaluation Form (SSA-538)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/10/2009
	Date Received in OIRA: 06/10/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2012	36 Months From Approved	08/31/2009
Responses	16,896	0	17,000
Time Burden (Hours)	3,379	0	3,400
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA’s regional review component use Form SSA-536 to facilitate the contract medical or psychological consultant’s review of the Childhood Disability Evaluation Form. The form records the reviewing consultant’s assessment of the evaluation prepared by the adjudicating component. The consultant completes an SSA-536 for each Title XVI childhood disability case he or she reviews because a Childhood Disability Evaluation Form is required in each case. Respondents are consultants who review the adjudicating component’s completion of the Childhood Disability Evaluation Form (SSA-538).

---

Authorizing Statute(s): US Code: 42 USC 1383b Name of Law: Social Security Act
   US Code: 42 USC 421 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 8607	02/25/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 19261	04/28/2009
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Medical or Psychological Consultant's Review of Childhood Disability Evaluation Form (SSA-538)	SSA-536	Medical or Psychological Consultant's Review of Childhood Disability Evaluation Form

---

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	16,896	17,000	0	0	-104	0
Annual Time Burden (Hours)	3,379	3,400	0	0	-21	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: Prior to ROCIS, we rounded the numbers up to 17,000. However, since ROCIS does not round the numbers in the same way, we are using the ROCIS calculations at this time. The estimated numbers of respondents and burden hours have not changed.

---

Annual Cost to Federal Government: $52,360

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)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 06/10/2009

---