Information Collection

Medical Report (General)

IC 8971 under ICR 201005-0960-005 · OMB 0960-0052.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3826 Medical Report (General) Medical Report (General)	Form
SSA-3826 Medical Report (General) ssa3826(revised).pdf	Form
ssa3826.pdf Form SSA-3826 (current)	IC Document

IC Title:

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:

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-3826				No		Paper Only

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	150,000	150,000
Annual IC Time Burden (Hours)	75,000	75,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form SSA-3826 (current)		07/02/2010

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

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