Information Collection

Private Sector

IC 184838 under ICR 200905-0960-007 · OMB 0960-0635.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0635 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3380 Private Sector	Form and Instruction
SSA-3380 Function Report--Adult--Third Party SSA-3380--Revised Version.pdf	Form and Instruction
Current SSA-3380.pdf SSA-3380 -- Current Version	IC Document

IC Title:

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 416.912 20 CFR 404.1512

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-3380	Function Report--Adult--Third Party	SSA-3380--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: 500,000

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	500,000	0	500,000
Annual IC Time Burden (Hours)	508,333	8,333	500,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-3380 -- Current Version	Current SSA-3380.pdf	07/01/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.