Information Collection

Disability Report - Child (Paper) SSA-3820

IC 9538 under ICR 201906-0960-006 · OMB 0960-0577.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0577 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3820-BK Disability Report - Child (Paper) SSA-3820	Form
0960-0577 Privacy Act Statement (revised).doc	Other-Revised Privacy Act Statement
SSA-3820-BK Disability Report - Child SSA-3820-BK (revised).pdf	Form
SSA-3820-BK (current).pdf SSA-3820-BK Disability Report -Child Current Version	IC Document

IC Title:

Disability Report - Child (Paper) SSA-3820

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.912

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3820-BK	Disability Report - Child	SSA-3820-BK (revised).pdf		Yes	No	Fillable Printable
Other-Revised Privacy Act Statement 0577			0960-0577 Privacy Act Statement (revised).doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 177,572

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	177,572	-101,430	279,002
Annual IC Time Burden (Hours)	266,358	-152,145	418,503
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-3820-BK Disability Report -Child Current Version	SSA-3820-BK (current).pdf	09/19/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.