Information Collection

Medical Report (Individual with Childhood Impairment)

IC 9059 under ICR 200712-0960-004 · OMB 0960-0102.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3827 Medical Report (Individual with Childhood Impairment)	Form and Instruction
SSA-3827 Medical Report (Individual with Childhood Impairment) 0960-0102.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.1624 20 CFR 416.912-.915 20 CFR 416.1024 20 CFR 404.1512-.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 and Instruction	SSA-3827	Medical Report (Individual with Childhood Impairment)	0960-0102.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: 12,000

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	Previously Approved
Annual Number of Responses for this IC	12,000	12,000
Annual IC Time Burden (Hours)	6,000	6,000
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.