MEDICAL REPORT - GENERAL

ICR 198903-0960-005

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
114446 Migrated
ICR Details
0960-0052 198903-0960-005
Historical Active 198603-0960-014
SSA
MEDICAL REPORT - GENERAL
Extension without change of a currently approved collection   No
Regular
Approved without change 05/16/1989
Retrieve Notice of Action (NOA) 03/23/1989
  Inventory as of this Action Requested Previously Approved
05/31/1992 05/31/1992 05/31/1989
750,000 0 750,000
375,000 0 375,000
0 0 0

THE INFORMATION COLLECTED ON FORM SSA-3826 IS NEEDED TO DETERMINE AND DOCUMENT THE CLAIMANT'S PHYSICAL STATUS PRIOR TO MAKING A DISABILITY DETERMINATION. THE RESPONDENTS ARE THE CLAIMANT'S TREATING MEDICAL SOURCES, AND MAY BE PHYSICIANS, MEDICAL DIRECTORS, HOSPITALS OR MEDICAL RECORD LIBRARIANS.

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.
03/23/1989


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