OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

0960-0681 - Function Report-Adult

IC 234811 under ICR 202002-0960-008 · OMB 0960-0813.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form SSA-3373
Function Report - Adult 0960-0681 - Function Report-Adult		 Form
SSA-3373 Function Report - Adult
SSA-3373 - Revised Version.pdf 		Form
Supporting Statement - 0681 (for RIN 0960-AH86).docx
Supporting Statement - 0681 (for RIN 0960-AH86)		IC Document
Addendum - 0681 (for RIN 0960-AH86).docx
Addendum - 0681 (for RIN 0960-AH86)		IC Document
SSA-3373 - Current Version.pdf
SSA-3373 - Current Version		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-3373 No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 1,734,635 0 0 1,734,635 0 0
Annual IC Time Burden (Hours) 1,763,546 0 0 1,763,546 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Supporting Statement - 0681 (for RIN 0960-AH86) 02/25/2020
Addendum - 0681 (for RIN 0960-AH86) 02/25/2020
SSA-3373 - Current Version 01/31/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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