Information Collection

Medical Report (Individual with Childhood Impairment)

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medical Report (Individual with Childhood Impairment)	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:

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 %

	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

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.