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Federal forms, ICRs, and supporting documents

Information Collection

Certificate of Incapacity

IC 44832 under ICR 201903-0960-011 · OMB 0960-0739.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Certificate of Incapacity
 
No Modified
 
Required to Obtain or Retain Benefits
 
5 CFR 890.302(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-604 Certificate of Incapacity SSA-604 (revised).pdf No   Paper Only

Income Security General Retirement and Disability

 

50 0
   
Private Sector Businesses or other for-profits
 
   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 50 0 0 0 0 50
Annual IC Time Burden (Hours) 38 0 0 0 0 38
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Certificate of Incapacity (current verison) SSA-604 (current).pdf 07/18/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.