Information Collection

Medical Report (General)

IC 8971 under ICR 200708-0960-011 · OMB 0960-0052.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0052 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3826 Medical Report (General)	Form
SSA-3826 Medical Report (General) SSA-3826 -- Revised Version.pdf	Form

IC Title:

Medical Report (General)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.912-416.915 20 CFR 404.1512-404.1515

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
Form	SSA-3826	Medical Report (General)	SSA-3826 -- Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150,000	-600,000	750,000
Annual IC Time Burden (Hours)	75,000	-300,000	375,000
Annual IC Cost Burden (Dollars)	0	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.