Information Collection

Physical Residual Functional Capacity Assessment, Mental Residual Functional Capacity Assessment

IC 115529 under ICR 199310-0960-003 · OMB 0960-0431.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	PHYSICAL RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT, MENTAL RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4734-U8				No	No
Form	4734-F4-SUP				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,382,670	27,170	1,355,500
Annual IC Time Burden (Hours)	460,890	13,575	447,315
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.