REPORT OF NEW INFORMATION IN DISABILITY CASES

ICR 199009-0960-005

OMB: 0960-0071

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
114540 Migrated
ICR Details
0960-0071 199009-0960-005
Historical Active 198710-0960-002
SSA
REPORT OF NEW INFORMATION IN DISABILITY CASES
Revision of a currently approved collection   No
Regular
Approved without change 11/20/1990
Retrieve Notice of Action (NOA) 09/19/1990
  Inventory as of this Action Requested Previously Approved
11/30/1993 11/30/1993 12/31/1990
200,000 0 200,000
16,667 0 16,666
0 0 0

THE INFORMATION COLLECTED BY USE OF THE FORM SSA-612 IS USED TO DETERMINE CONTINUING ELIGIBILITY FOR DISABILITY BENEFITS. THE AFFECTED PUBLIC IS COMPRISED OF DISABILITY BENEFICIARIES WHO HAVE EXPERIENCE CHANGES IN THEIR MEDICAL/LIVING CONDITIONS.

None
None


No

1
IC Title Form No. Form Name
REPORT OF NEW INFORMATION IN DISABILITY CASES SSA-612

  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 200,000 200,000 0 0 0 0
Annual Time Burden (Hours) 16,667 16,666 0 1 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
09/19/1990


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