Medical History and Disability Report (Disabled Child)

ICR 199712-0960-002

OMB: 0960-0574

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0574 199712-0960-002
Historical Active 199706-0960-004
SSA
Medical History and Disability Report (Disabled Child)
Extension without change of a currently approved collection   No
Regular
Approved without change 01/21/1998
Retrieve Notice of Action (NOA) 12/04/1997
  Inventory as of this Action Requested Previously Approved
12/31/1998 12/31/1998 01/31/1998
523,000 0 523,000
174,333 0 174,333
0 0 0

The information collected on form SSA-3820-F4 is needed for the determination of disaiblity by the State DDSs to obtain various types of information about a child's condition, his/her treating sources, and/or other medical sources of evidence. The respondents are SSI claimants who are applying for disabled child's benefits.

None
None


No

1
IC Title Form No. Form Name
Medical History and Disability Report (Disabled Child) SSA-3820-F4

  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 523,000 523,000 0 0 0 0
Annual Time Burden (Hours) 174,333 174,333 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.
12/04/1997


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