Medical History and Disability Report

ICR 199506-0960-021

OMB: 0960-0504

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
115687 Migrated
ICR Details
0960-0504 199506-0960-021
Historical Inactive 199410-0960-003
SSA
Medical History and Disability Report
Revision of a currently approved collection   No
Regular
Withdrawn and continue 09/27/1995
Retrieve Notice of Action (NOA) 06/30/1995
Withdrawn, and continue, at agency request.
  Inventory as of this Action Requested Previously Approved
01/31/1998 01/31/1998
523,000 0 0
343,667 0 0
0 0 0

The information obtained by form SSA-3820 is used by SSA to help make a determination in claims for disabled children. The respondents are claimants for those benefits who may be entitled because of alleged disabilities.

None
None


No

1
IC Title Form No. Form Name
Medical History and Disability Report SSA-3820

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.
06/30/1995


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