Medical Consultant's Review of Physical Residual Functional Capacity Assessment

Forms and Documents

Document Name	Status
addendum 0680.doc Supplementary Document	2009-09-30
0960-0680 supporting statement Revised.doc Supporting Statement A	2009-09-30

IC Document Collections

IC ID	Document Title	Status
38066	Medical Consultant's Review of Physical Residual Functional Capacity Assessment Other-AeDIB Screens for the SSA-392	Modified

ICR Details

OMB Control No: 0960-0680	ICR Reference No: 200906-0960-004
Status: Historical Active	Previous ICR Reference No: 200609-0960-011
Agency/Subagency: SSA	Agency Tracking No:
Title: Medical Consultant's Review of Physical Residual Functional Capacity Assessment
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: 11/10/2009
	Date Received in OIRA: 09/30/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved	12/31/2009
Responses	91,904	0	91,904
Time Burden (Hours)	18,381	0	18,380
Cost Burden (Dollars)	0	0	0

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Abstract: Form SSA-392 is used by the Social Security Administration's regional review component to facilitate the medical consultant's review of the Physical Residual Functional Capacity Form (PR). The SSA-392 records the reviewing medical consultant's assessment of the PR prepared by the adjudicating component. The medical consultant only completes an SSA-392 when the adjudicating component's PR is in the claims file. The SSA-392 is required for each PR completed. Respondents are medical consultants who review the adjudicating component's completion of the PR for quality purposes.

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

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:
	74 FR 37081	07/27/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 48795	09/24/2009
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 Consultant's Review of Physical Residual Functional Capacity Assessment

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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	91,904	91,904	0	0	0	0
Annual Time Burden (Hours)	18,381	18,380	0	1	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: There has not been a increase in burden hours, ROCIS rounds up the numbers inputted.

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Annual Cost to Federal Government: $0

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

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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: 09/30/2009

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