Report on Individual with Mental Impairment--State DDSs

Report on Individual with Mental Impairment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0058 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-824 Report on Individual with Mental Impairment--State DDSs Form
SSA-824 Report on Individual with Mental Impairment SSA-824.pdf Form

Information Collection (IC) Details

IC Title:	Report on Individual with Mental Impairment--State DDSs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.913 20 CFR 404.1513

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-824	Report on Individual with Mental Impairment	SSA-824.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: 25,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	25,000	25,000
Annual IC Time Burden (Hours)	15,000	15,000
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.