REPORT ON INDIVIDUAL WITH MENTAL IMPAIRMENT

ICR 199003-0960-002

OMB: 0960-0058

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
114463 Migrated
ICR Details
0960-0058 199003-0960-002
Historical Active 198705-0960-002
SSA
REPORT ON INDIVIDUAL WITH MENTAL IMPAIRMENT
Revision of a currently approved collection   No
Regular
Approved without change 06/07/1990
Retrieve Notice of Action (NOA) 03/14/1990
  Inventory as of this Action Requested Previously Approved
06/30/1993 06/30/1993 06/30/1990
50,000 0 50,000
30,000 0 30,000
0 0 0

THE INFORMATION COLLECTED BY THE FORM SSA-824 WILL BE USED TO DETERMIN A CLAIMANT'S PHYSICAL AND MENTAL STATUS PRIOR TO MAKING A DISABILITY DETERMINATION. THE AFFECTED PUBLIC CONSISTS OF TREATING PHYSICIANS, MEDICAL DIRECTORS, MEDICAL RECORD LIBRARIES AND OTHER HEALTH PROFESSIONALS.

None
None


No

1
IC Title Form No. Form Name
REPORT ON INDIVIDUAL WITH MENTAL IMPAIRMENT SSA-824

  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 50,000 50,000 0 0 0 0
Annual Time Burden (Hours) 30,000 30,000 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.
03/14/1990


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