REPORT OF NEW INFORMATION IN DISABILITY CASES

ICR 197701-0960-003

OMB: 0960-0071

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
114536 Migrated
ICR Details
0960-0071 197701-0960-003
Historical Active 197701-0960-002
SSA
REPORT OF NEW INFORMATION IN DISABILITY CASES
Extension without change of a currently approved collection   No
Regular
Approved without change 02/07/1977
Retrieve Notice of Action (NOA) 01/28/1977
  Inventory as of this Action Requested Previously Approved
01/31/1982 01/31/1982 05/31/1977
200,000 0 400,000
16,666 0 33,333
0 0 0

SECTION 224 OF THE SOCIAL SECURITY ACT PROVIDES FRO INFORMATION REGARDING REDUCTION OF DISABILITY BENEFITS DUE TO WORKMEN'S COMPENSATION. THIS FORM IS ALSO USED TO REPORT OTHER INFORMATION THAT MAY AFFECT CONTINUING ENTITLEMENT TO DISABILITY BENEFITS.

None
None


No

1
IC Title Form No. Form Name
REPORT OF NEW INFORMATION IN DISABILITY CASES SSA-612

  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 200,000 400,000 0 0 -200,000 0
Annual Time Burden (Hours) 16,666 33,333 0 0 -16,667 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
01/28/1977


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