Information Collection

Disability Report - Adult, 20 CFR 404.1512 and 416.912

IC 9548 under ICR 200608-0960-012 · OMB 0960-0579.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0579 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
i3368 Proposed Review & Send 08-21-06.doc s044a90.ssa.gov/apps6z/i3369/ee001-fe.jsp	Other-Internet Collection Screen
i3368 current Review & Send Screen.doc s044a90.ssa.gov/apps6z/i3369/ee001-fe.jsp	Other-Internat Collection Screen

IC Title:

Disability Report - Adult, 20 CFR 404.1512 and 416.912

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Collection Screen			i3368 Proposed Review & Send 08-21-06.doc	https://s044a90.ssa.gov/apps6z/i3369/ee001-fe.jsp	Yes	Yes	Fillable Fileable
Other-Internat Collection Screen			i3368 current Review & Send Screen.doc	https://s044a90.ssa.gov/apps6z/i3369/ee001-fe.jsp	Yes	Yes	Fillable Fileable

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,116,667

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 7 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,116,667	2,116,667
Annual IC Time Burden (Hours)	2,257,667	2,257,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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