Medical History and Disability Report

Medical History and Disability Report

OMB: 0960-0504

IC ID: 115687

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Information Collection (IC) Details

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Medical History and Disability Report
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-3820 No No


    

523,000 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 532,000 0 0 532,000 0 0
Annual IC Time Burden (Hours) 343,667 0 0 343,667 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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