Medical Consultant's Review of Physical Residual Functional Capacity Assessment

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medical Consultant's Review of Physical Residual Functional Capacity Assessment	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:

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 %

	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

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.