Disability Report

ICR 199810-0960-006

OMB: 0960-0573

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
38037 Migrated
ICR Details
0960-0573 199810-0960-006
Historical Active 199712-0960-005
SSA
Disability Report
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 10/01/1998
Retrieve Notice of Action (NOA) 10/01/1998
  Inventory as of this Action Requested Previously Approved
12/31/1998 12/31/1998 12/31/1998
85,280 0 2,438,496
63,960 0 1,828,872
0 0 0

The information collected on form SSA-3368 is needed for the determination of disability by the State Disability Determination Services. The information will be used to develop medical evidence and to assess the alleged disability. The respondents are applicants for disability benefits.

None
None


No

1
IC Title Form No. Form Name
Disability Report SSA-3368-F6

  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 85,280 2,438,496 0 -2,353,216 0 0
Annual Time Burden (Hours) 63,960 1,828,872 0 -1,764,912 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.
10/01/1998


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