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Medical Report (General)
Medical Report (General)
OMB: 0960-0052
IC ID: 8971
OMB.report
SSA
OMB 0960-0052
ICR 201005-0960-005
IC 8971
( )
Documents and Forms
Document Name
Document Type
Form SSA-3826
Medical Report (General)
Form
SSA-3826 Medical Report (General)
ssa3826(revised).pdf
Form
ssa3826.pdf
Form SSA-3826 (current)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medical Report (General)
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 416.912-416.915
20 CFR 404.1512-404.1515
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-3826
Medical Report (General)
ssa3826(revised).pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
150,000
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
150,000
0
0
0
0
150,000
Annual IC Time Burden (Hours)
75,000
0
0
0
0
75,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Form SSA-3826 (current)
ssa3826.pdf
07/02/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
