Medical Source Statement of Ability To Do Work-Related Activities: Physical and Mental

Medical Source Statement of Ability to Do Work-Related Activities,

OMB: 0960-0662

IC ID: 9709

Information Collection (IC) Details

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Medical Source Statement of Ability To Do Work-Related Activities: Physical and Mental
 
No Modified
 
Voluntary
 
20 CFR 404.1512

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HA-1151 MEDICAL SOURCE STATEMENT OF ABILITY TO DO WORK-RELATED ACTIVITIES (PHYSICAL) HA-1151 1-2006 revision.doc No   Paper Only
Form HA-1151 09-05 EDITION Medical Source Statement of Ability To Do Work-Related Activities (Physical) HA-1151 09-05 EDITION.doc No   Paper Only

Income Security General Retirement and Disability

 

10,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 200,000 0 0 0 0 200,000
Annual IC Time Burden (Hours) 50,000 0 0 0 0 50,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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