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0960-0579 - SSA-3368 - Disability Report-Adult

IC 234806 under ICR 202002-0960-008 · OMB 0960-0813.

Documents and Forms
Document Name
Document Type
Form
Other-EDCS Screens
Other-i3368 Screens
Form
IC Document
IC Document
IC Document
Information Collection (IC) Details

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0960-0579 - SSA-3368 - Disability Report-Adult
 
No Modified
 
Voluntary
 
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 SSA-3368 Disability Report - Adult SSA-3368 - Revised Version.pdf No   Paper Only
Other-EDCS Screens EDCS 3368 Screens.pdf Yes Yes Fillable Fileable Signable
Other-i3368 Screens i3368 screenshots.pdf Yes Yes Fillable Printable

Income Security General Retirement and Disability

 

2,258,510 0
   
Individuals or Households
 
   99 %

  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 2,258,510 0 0 2,258,510 0 0
Annual IC Time Burden (Hours) 3,387,766 0 0 3,387,766 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement - 0579 (for RIN 0960-AH86) Supporting Statement - 0579 (for RIN 0960-AH86).docx 02/25/2020
Addendum - 0579 (for RIN 0960 AH86) Addendum - 0579 (for RIN 0960 AH86).docx 02/25/2020
SSA-3368 - Current Version SSA-3368 - Current Version.pdf 01/31/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.