MEDICAL REPORT (INDIVIDUAL WITH CHILDHOOD IMPAIRMENT)

ICR 199108-0960-006

OMB: 0960-0102

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
114669 Migrated
ICR Details
0960-0102 199108-0960-006
Historical Active 198808-0960-002
SSA
MEDICAL REPORT (INDIVIDUAL WITH CHILDHOOD IMPAIRMENT)
Extension without change of a currently approved collection   No
Regular
Approved without change 10/21/1991
Retrieve Notice of Action (NOA) 08/07/1991
This information collection is approved through 10-92 under the following conditions:SSA will need to modify this paperwork to reflect changes in the way the Agency evaluates childhood disability claims, as mandated by the Zebley decision.
  Inventory as of this Action Requested Previously Approved
10/31/1992 10/31/1992 10/31/1991
75,000 0 75,000
37,500 0 37,500
0 0 0

THE INFORMATION COLLECTED BY FORM SSA-3827 IS USED BY THE SOCIAL SECURITY ADMINISTRATION (SSA) TO DETERMINE IF AN INDIVIDUAL WITH A CHILDHOOD IMPAIRMENT MEDICALLY QUALIFIES FOR BENEFITS OR PAYMENTS UNDE THE PROVISIONS OF THE SOCIAL SECURITY ACT. WITHOUT THIS DATA SSA WOUL NOT BE ABLE TO PROPERLY EVALUATE THE MEDICAL ASPECTS OF AN INDIVIDUAL' CLAIM OR APPLICATION. THE AFFECTED PUBLIC CONSISTS OF ATTENDING

None
None


No

1
IC Title Form No. Form Name
MEDICAL REPORT (INDIVIDUAL WITH CHILDHOOD IMPAIRMENT) SSA-3827

  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 75,000 75,000 0 0 0 0
Annual Time Burden (Hours) 37,500 37,500 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.
08/07/1991


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