Information Collection

Disability Report - Child (Internet)

IC 179519 under ICR 201304-0960-010 · OMB 0960-0577.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0577 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
combined i3820 screens(revised).pdf eis.ba.ssa.gov/i3820	Other-Disability Report - Child (Int
i3820_internet_screens_(current).pdf i3820 internet screens (current)	IC Document

IC Title:

Disability Report - Child (Internet)

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

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
Other-Disability Report - Child (Internet)			combined i3820 screens(revised).pdf	http://eis.ba.ssa.gov/i3820	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 540,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 8 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	540,000	446,707	93,293
Annual IC Time Burden (Hours)	540,000	353,414	186,586
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
i3820 internet screens (current)	i3820_internet_screens_(current).pdf	07/22/2013

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