Medical Report (Individual with Childhood Impairment)

ICR 199811-0960-002

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
9057 Migrated
ICR Details
0960-0102 199811-0960-002
Historical Active 199511-0960-006
SSA
Medical Report (Individual with Childhood Impairment)
Extension without change of a currently approved collection   No
Regular
Approved without change 01/08/1999
Retrieve Notice of Action (NOA) 11/13/1998
  Inventory as of this Action Requested Previously Approved
01/31/2002 01/31/2002 01/31/1999
12,000 0 12,000
6,000 0 6,000
0 0 0

The information collected on form SSA-3827 is used by SSA to determine whether an individual with a childhood impairment medically qualifies for benefits or payments under the provisions of the Social Security Act, based on the medical aspects of an individual's claim or application. The respondents are 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.
11/13/1998


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