Information Collection

Medical Report Forms (required - Disability Determinations)

IC 176961 under ICR 197512-3220-003 · OMB 3220-0038.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0038 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	MEDICAL REPORT FORMS (REQUIRED - DISABILITY DETERMINATIONS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	G-3, G-3X	No	No
Form	G-3EMP	No	No
Form	G-250, 250X	No	No
Form	G-251, 252	No	No
Form	G-253A,	No	No
Form	G-257	No	No
Form	G-258	No	No
Form	G-260	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24,250	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	24,250	24,250
Annual IC Time Burden (Hours)	4,040	4,040
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.