Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits

ICR 199801-0960-002

OMB: 0960-0024

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
0960-0024 199801-0960-002
Historical Active 199411-0960-004
SSA
Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits
Extension without change of a currently approved collection   No
Regular
Approved without change 03/04/1998
Retrieve Notice of Action (NOA) 01/06/1998
  Inventory as of this Action Requested Previously Approved
03/31/2001 03/31/2001 03/31/1998
120,000 0 120,000
20,000 0 20,000
0 0 0

The Social Security Administration uses the information collected on form SSA-787 to determine whether an individual is capable of handling his/her benefits. The information is also used for leads in selecting a representative payee, if needed.

None
None


No

1
IC Title Form No. Form Name
Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits SSA-787

  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 120,000 120,000 0 0 0 0
Annual Time Burden (Hours) 20,000 20,000 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.
01/06/1998


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