Function Report - Adult Third Party

ICR 200106-0960-001

OMB: 0960-0635

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
9662 Migrated
ICR Details
0960-0635 200106-0960-001
Historical Active
SSA
Function Report - Adult Third Party
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/31/2001
Retrieve Notice of Action (NOA) 06/01/2001
  Inventory as of this Action Requested Previously Approved
07/31/2004 07/31/2004
1,500,000 0 0
750,000 0 0
0 0 0

The information collected from third parties on the form SSA-3380 is needed for the determination of disability under Title II (Old-Age, Survivors and Disability Insurance (OASDI) and/or Title XVI (Supplemental Security Income (SSI)). The form records information aobut the disability applicant's illnesses, injuries, conditions, impairment-related limitations and ability to function. The respondents are individuals who know about the disability applicant's impairment, limitations and ability to function.

None
None


No

1
IC Title Form No. Form Name
Function Report - Adult Third Party SSA-3380

  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 1,500,000 0 0 1,500,000 0 0
Annual Time Burden (Hours) 750,000 0 0 750,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
06/01/2001


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