Medical Report, Individual With Childhood Impairment

ICR 199511-0960-006

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
9056 Migrated
ICR Details
0960-0102 199511-0960-006
Historical Active 199209-0960-007
SSA
Medical Report, Individual With Childhood Impairment
Extension without change of a currently approved collection   No
Regular
Approved without change 12/28/1995
Retrieve Notice of Action (NOA) 11/05/1995
  Inventory as of this Action Requested Previously Approved
01/31/1999 01/31/1999 12/31/1995
12,000 0 12,000
6,000 0 6,000
0 0 0

The information collected by form SSA-3827 is used by SSA to determine if an individual with a childhood impairment medically qualifies for benefits or payments under the provisions of the Social Security Act. Without this data, SSA would not be able to properly evaluate the medical aspects of an individual's claim or application. The affected public consists of attending physicians/medical sources.

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 12,000 12,000 0 0 0 0
Annual Time Burden (Hours) 6,000 6,000 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.
11/05/1995


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