Information Collection

Residual Functional Capacity Assessment Mental Residual Functional Capacity Assessment

IC 166850 under ICR 198904-0960-008 · OMB 0960-0431.

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Information Collection (IC) Details

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IC Title:	RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT MENTAL RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4734				No	No
Form	SSA-4734SUP				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,355,500	1,355,500
Annual IC Time Burden (Hours)	447,315	447,315
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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