Information Collection

Disability Report - Child (Paper)

IC 9538 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⚠️ Notice: This information collection may be referencing outdated material.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
Form SSA-3820-BK Disability Report - Child (Paper)	Form and Instruction
SSA-3820-BK Disability Report - Child SSA-3820 (revised).pdf	Form and Instruction
SSA-3820 (current).pdf SSA-3820 (current)	IC Document

IC Title:

Disability Report - Child (Paper)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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
Form and Instruction	SSA-3820-BK	Disability Report - Child	SSA-3820 (revised).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	0	500
Annual IC Time Burden (Hours)	750	250	500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-3820 (current)	SSA-3820 (current).pdf	09/12/2013

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