Application and Statement - SSA-3192

Medical Permit Parking Application

OMB: 0960-0624

IC ID: 9641

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Application and Statement - SSA-3192
 
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-3192 Application and Statement SSA-3192 (revised).pdf No   Paper Only

General Government Central Personnel

 

390 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 390 0 0 0 0 390
Annual IC Time Burden (Hours) 195 0 0 0 0 195
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-3192 SSA-3192 current.pdf 02/07/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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