Information Collection

Report on Individual with Mental Impairment--Private Sector

IC 8976 under ICR 200808-0960-002 · OMB 0960-0058.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-824 Report on Individual with Mental Impairment--Private Sector	Form
SSA-824 Report on Individual with Mental Impairment SSA-824.pdf	Form

IC Title:

Report on Individual with Mental Impairment--Private Sector

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 416.913 20 CFR 404.1513

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-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: Private Sector

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

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	25,000	-25,000	50,000
Annual IC Time Burden (Hours)	15,000	-15,000	30,000
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.