Claimant's Recent Medical Treatment

Claimant's Recent Medical Treatment

OMB: 0960-0292

IC ID: 9198

Information Collection (IC) Details

View Information Collection (IC)

Claimant's Recent Medical Treatment
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.912 20 CFR 404.1512

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HA-4631 CLAIMANT'S RECENT MEDICAL TREATMENT HA-4631(revised).pdf http://www.ssa.gov/online/ha-4631.html. Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

200,000 0
   
Individuals or Households
 
   80 %

  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 200,000 0 0 0 0 200,000
Annual IC Time Burden (Hours) 33,333 0 0 0 0 33,333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HA-4631 Current Version HA-4631 (current).pdf 03/17/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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