Work History Report

ICR 199710-0960-004

OMB: 0960-0552

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
38022 Migrated
ICR Details
0960-0552 199710-0960-004
Historical Active 199608-0960-002
SSA
Work History Report
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 10/06/1997
Retrieve Notice of Action (NOA) 10/06/1997
  Inventory as of this Action Requested Previously Approved
04/30/1998 04/30/1998 02/28/1998
32,000 0 2,000,000
16,000 0 1,000,000
0 0 0

The information collected on form SSA-3369 is used to document a claimant's work history and used, in conjunction with other evidence, to determine eligibility for disability benefits. The respondents are claimants for disability benefits.

None
None


No

1
IC Title Form No. Form Name
Work History Report SSA-3369

  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 32,000 2,000,000 0 -1,968,000 0 0
Annual Time Burden (Hours) 16,000 1,000,000 0 -984,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
10/06/1997


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