MEDICAL REPORT (INDIVIDUAL WITH CHILDHOOD IMPAIRMENT)

ICR 197903-0960-015

OMB: 0960-0102

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
166569 Migrated
ICR Details
0960-0102 197903-0960-015
Historical Active 197809-0960-012
SSA
MEDICAL REPORT (INDIVIDUAL WITH CHILDHOOD IMPAIRMENT)
No material or nonsubstantive change to a currently approved collection   No
Emergency 03/28/1979
Approved with change 03/28/1979
Retrieve Notice of Action (NOA) 03/28/1979
  Inventory as of this Action Requested Previously Approved
01/31/1983 01/31/1983 01/31/1983
75,000 0 75,000
37,500 0 37,500
0 0 0

SECTION 216(I) AND 1614(A) 1 OF THE SOCIAL SECURITY ACT PROVIDES FOR "DISABILITY" REGARDING THE ESTABLISHMENT OF ENTITLEMENT TO DISABILITY BENEFITS. THIS FORM IS USED TO DETERMINE THE SEVERITY OF A CLAIMANT'S IMPAIRMENT FOR PURPOSES OF DECIDING ENTITLEMENT TO BENEFITS.

None
None


No

1
IC Title Form No. Form Name
MEDICAL REPORT (INDIVIDUAL WITH CHILDHOOD IMPAIRMENT) SSA-3827

  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 75,000 75,000 0 0 0 0
Annual Time Burden (Hours) 37,500 37,500 0 0 0 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.
03/28/1979


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