Medical Source Statement of Ability to Do Work-Related Activities
No material or nonsubstantive change to a currently approved collection
No
Regular
01/16/2025
Requested
Previously Approved
11/30/2027
11/30/2027
343,600
300,000
78,633
75,000
0
0
When a claimant appeals a denied disability claim, SSA may ask the claimant to have a consultative examination at the agencyâs expense, if the claimantâs medical sources cannot, or will not, give the agency sufficient evidence to determine whether the claimant is disabled. The medical providers who perform these consultative examinations provide a statement about the claimantâs state of disability. Specifically, these medical source statements determine the work-related capabilities of these claimants. SSA collects the medical data on the HA-1151 and HA-1152 to assess the work-related physical and mental capabilities of claimants who appeal SSAâs previous determination on their issue of disability. The respondents are medical sources who provide reports based either on existing medical evidence or on consultative examinations.
We are submitting this Change Request to include two CFR citations from the rule-related ICR for 0960-0804 under this OMB approval. We will also submit the Discontinuation for 0960-0804 at the same time as we submit this Change Request. The addtion of these CFR ciations will increase the burden for this information collection.
US Code:
42 USC 1381
Name of Law: Social Security Act
US Code:
42 USC 902
Name of Law: Social Security Act
We are increasing the burden for this ICR to include the burdens associated with the CFR citations 20 CFR 404.1740(b)(5)&(6), and 416.1540 (b)(5)&(6). These citations were previously listed under OMB Number 0960-0804 (the rule-related ICR); however, as we are discontinuing that ICR, we are including the burden here (see the Justification for the Non-Substantive Changes document for more information).
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.
Form HA-1151-BK Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151
Justification for the Non-Substantive Changes - 0662.docx
Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151