Physician's Report

Medical Permit Parking Application

OMB: 0960-0624

IC ID: 186165

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Physician's Report
 
No Modified
 
Required to Obtain or Retain Benefits
 
41 CFR 101.20-104.2

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-3193 Physician's Report Final Physician Report.doc No   Paper Only

General Government Central Personnel

 

400 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 400 0 0 0 0 400
Annual IC Time Burden (Hours) 600 0 0 0 0 600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3193 Physician's Report SSA-3193.pdf 07/11/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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