Physician's Report - SSA-3193

Medical Permit Parking Application

OMB: 0960-0624

IC ID: 186165

Documents and Forms
Information Collection (IC) Details

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Physician's Report - SSA-3193
 
No Modified
 
Required to Obtain or Retain Benefits
 
41 CFR 102-71.20 41 CFR 102-74.305  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-3193 Physician's Report SSA-3193 (2017) Mock-up.pdf No   Paper Only

General Government Central Personnel

 

465 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 465 0 0 -115 0 580
Annual IC Time Burden (Hours) 698 0 0 -172 0 870
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-3193 ssa3193(current).pdf 07/19/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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