MEDIC DATA COLLECTION FORM

ICR 198904-0960-032

OMB: 0960-0383

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
166828 Migrated
ICR Details
0960-0383 198904-0960-032
Historical Active 198904-0960-020
SSA
MEDIC DATA COLLECTION FORM
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/27/1989
Approved with change 04/27/1989
Retrieve Notice of Action (NOA) 04/27/1989
  Inventory as of this Action Requested Previously Approved
11/30/1990 11/30/1990 11/30/1990
287,729 0 287,729
23,977 0 23,977
0 0 0

THE INFORMATION COLLECTED ON THE SSA-1419 IS USED BY THE SOCIAL SECURITY ADMINISTRATION TO DEVELOP NATIONAL COST STANDAR TO DEVELOP THE ALLOCATION OF BUDGETED RESOURCES, TO PREDICT TRENDS REGARDING SUBPROCESSES, AND TO PINPOINT INEFFECTIVE OR INEFFICIENT OPERATIONS IN THE STATE AGENCIES. THE AFFECTED PUBLIC CONSISTS OF OF DISABILITY DETERMINATION SERVICES IN THE VARIOUS STATES.

None
None


No

1
IC Title Form No. Form Name
MEDIC DATA COLLECTION FORM SSA-1419

  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 287,729 287,729 0 0 0 0
Annual Time Burden (Hours) 23,977 23,977 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.
04/27/1989


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