Information Collection

Pain Report - Child

IC 9452 under ICR 200911-0960-001 · OMB 0960-0540.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0540 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3371-BK Pain Report - Child	Form
SSA-3371-BK Pain Report-Child ssa-3371 (revised).pdf	Form

IC Title:

Pain Report - Child

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 404.512

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-3371-BK	Pain Report-Child	ssa-3371 (revised).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: 250,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	250,000	250,000
Annual IC Time Burden (Hours)	62,500	62,500
Annual IC Cost Burden (Dollars)	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.