MEDICAL REPORT - GENERAL

ICR 198005-0960-005

OMB: 0960-0052

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
166461 Migrated
ICR Details
0960-0052 198005-0960-005
Historical Active 198002-0960-006
SSA
MEDICAL REPORT - GENERAL
No material or nonsubstantive change to a currently approved collection   No
Emergency 05/29/1980
Approved with change 05/29/1980
Retrieve Notice of Action (NOA) 05/29/1980
  Inventory as of this Action Requested Previously Approved
07/31/1980 07/31/1980 06/30/1980
750,000 0 750,000
375,000 0 375,000
0 0 0



None
None


No

1
IC Title Form No. Form Name
MEDICAL REPORT - GENERAL SSA-3826

  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 750,000 750,000 0 0 0 0
Annual Time Burden (Hours) 375,000 375,000 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.
05/29/1980


© 2024 OMB.report | Privacy Policy