Disability Report - Adult, (Fillable PDF)

Disability Report - Adult

OMB: 0960-0579

IC ID: 9548

Information Collection (IC) Details

View Information Collection (IC)

Disability Report - Adult, (Fillable PDF)
 
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 and Instruction SSA-3368 Disability Report - Adult SSA-3368-BK Revised (2015 Mock-up).pdf Yes No Fillable Printable

Income Security General Retirement and Disability

 

7,571 0
   
Individuals or Households
 
   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 7,571 0 0 -21,501 0 29,072
Annual IC Time Burden (Hours) 11,357 0 0 -17,715 0 29,072
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3368-BK -- Current Version ssa-3368 Current Version.pdf 04/29/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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