Information Collection

Medical Consultant's Review of Physical Residual Functional Capacity Assessment

IC 38066 under ICR 200906-0960-004 · OMB 0960-0680.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-392 (Revised).pdf co.ba.ssa.gov/eForms/forms/formselector.htm	Other-AeDIB Screens for the SSA-392

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 404.1545 20 CFR 404.1640 20 CFR 404.1643 20 CFR 404.1645 20 CFR 416.945-416.946 20 CFR 404.1546

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
Other-AeDIB Screens for the SSA-392			SSA-392 (Revised).pdf	http://co.ba.ssa.gov/eForms/forms/formselector.htm	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 256

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	91,904	0	91,904
Annual IC Time Burden (Hours)	18,381	1	18,380
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.