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Medical History And Disability Report - Widow, Widower, Surviving Divorced Wife, Disabled Child

IC 114910 under ICR 198706-0960-001 · OMB 0960-0147.

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MEDICAL HISTORY AND DISABILITY REPORT - WIDOW, WIDOWER, SURVIVING DIVORCED WIFE, DISABLED CHILD
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-3820 No No


    

134,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 134,000 0 0 0 0 134,000
Annual IC Time Burden (Hours) 44,667 0 0 0 0 44,667
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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