DISABILITY REPORT

ICR 199106-0960-004

OMB: 0960-0141

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
166659 Migrated
ICR Details
0960-0141 199106-0960-004
Historical Active 199009-0960-004
SSA
DISABILITY REPORT
No material or nonsubstantive change to a currently approved collection   No
Emergency 06/25/1991
Approved with change 06/25/1991
Retrieve Notice of Action (NOA) 06/25/1991
  Inventory as of this Action Requested Previously Approved
11/30/1993 11/30/1993 11/30/1993
2,200,000 0 2,200,000
1,100,000 0 1,100,000
0 0 0

THE INFORMATION COLLECTED BY THE USE OF FORM SSA-3368 IS NEEDED TO MAKE A DETERMINATION FOR A DISABILITY CLAIM. FORM SSA-3369 SUPPLEMENTS THE SSA-3368 REGARDING ADDITIONAL INFORMATION ABOUT PAST WORK EXPERIENCE. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS WHO FILE FOR DISABILITY BENEFITS.

None
None


No

1
IC Title Form No. Form Name
DISABILITY REPORT SSA-3368-F6

  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 2,200,000 2,200,000 0 0 0 0
Annual Time Burden (Hours) 1,100,000 1,100,000 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.
06/25/1991


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