Medical Report (General), 20 CFR 404.1512-.1515 and 416.912-.915

ICR 200408-0960-008

OMB: 0960-0052

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
0960-0052 200408-0960-008
Historical Active 200108-0960-006
SSA
Medical Report (General), 20 CFR 404.1512-.1515 and 416.912-.915
Extension without change of a currently approved collection   No
Regular
Approved without change 10/08/2004
Retrieve Notice of Action (NOA) 08/20/2004
  Inventory as of this Action Requested Previously Approved
10/31/2007 10/31/2007 10/31/2004
750,000 0 750,000
375,000 0 375,000
0 0 0

The information collected by form SSA-3826 is used by the Social Security Administration (SSA) to determine a claimant's physical status prior to making a disability determination, and to provide medical evidence for the disability claims folder. The respondents are members of the medical community such as physicians, hospitals, directors, and medical records librarians.

None
None


No

1
IC Title Form No. Form Name
Medical Report (General), 20 CFR 404.1512-.1515 and 416.912-.915 SSA-3826

  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 750,000 750,000 0 0 0 0
Annual Time Burden (Hours) 375,000 375,000 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.
08/20/2004


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