Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits

Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits

OMB: 0960-0024

IC ID: 8918

Information Collection (IC) Details

View Information Collection (IC)

Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.615 20 CFR 404.2015

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-787 Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits SSA-787 - Revised Version.pdf No   Paper Only

Income Security General Retirement and Disability

 

120,000 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 120,000 0 0 0 0 120,000
Annual IC Time Burden (Hours) 20,000 0 0 0 0 20,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-787 SSA-787 - Current Version.pdf 10/19/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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