OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Disability Report - Adult

ICR 201205-0960-003 · OMB 0960-0579 · Historical Active

Forms and Documents
Document
Name
Status
Form and Instruction
 Modified
Supplementary Document
2012-08-09
Supporting Statement A
2012-08-09
IC Document Collections
IC ID
Document
Title
Status
9548 Modified
179421 Removed
179420 Modified
179419 Modified
ICR Details
0960-0579 201205-0960-003
Historical Active 201104-0960-006
SSA
Disability Report - Adult
Revision of a currently approved collection   No
Regular
Approved without change 09/27/2012
Retrieve Notice of Action (NOA) 08/13/2012
  Inventory as of this Action Requested Previously Approved
09/30/2015 36 Months From Approved 11/30/2012
3,303,724 0 2,592,034
3,514,337 0 2,757,163
0 0 0
State Disability Determination Services (DDS) use the SSA–3368 and its electronic versions to determine if an adult disability applicant's impairment(s) is severe and, if so, how the impairment(s) affects the applicant's ability to work. This determination dictates whether the DDSs and SSA will find the applicant to be disabled. Therefore, the information the DDSs collect on this form is crucial in making disability determinations for all adult claimants filing for SSA disability benefits or Supplemental Security Income (SSI) payments. The respondents are applicants for title II disability benefits or title XVI SSI payments.
US Code: 42 USC 205(a) Name of Law: The Social Security Act
   US Code: 42 USC 223(d)(5)(A) Name of Law: The Social Security Act
   US Code: 42 USC 1631(e)(1) Name of Law: The Social Security Act
   US Code: 42 USC 1631(d)(1) Name of Law: The Social Security Act
  
None
Not associated with rulemaking
  77 FR 29441 05/17/2012
77 FR 47688 08/09/2012
No
  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 3,303,724 2,592,034 0 0 711,690 0
Annual Time Burden (Hours) 3,514,337 2,757,163 0 0 757,174 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Cutting Redundancy
We discontinued the i3368-PRO upon full implementation of the revised i3368 Internet application as promised in our last full information collection request. The i3368 absorbs the former i3368-PRO users. We successfully completed full implementation of the i3368 as promised in our last request. In addition, we periodically update the dollar amount for monthly gross earnings in questions on the paper form (See Addendum for more information).
$35,958,328
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/13/2012