Information Collection Request
RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { border-color: transparent; background-color: transparent; left: 250px; top:75px; width:1px; height:1px; color:black; overflow:hid
ICR 202101-0960-006 · OMB 0960-0662 · RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { b
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0960-0662 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form HA-1151-BK Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151 |
Form | Modified | Repair queued |
| Form HA-1152 Medical Source Statement of Ability to Do Work-Related Activities (Mental) - SSA-1152 |
Form | Modified | Available |
 Supporting Statement - 0662.docx |
Supporting Statement A | Uploaded 2021-01-28 | Repair queued |
| Addendum - 0662.docx |
Supplementary Document | Uploaded 2021-01-28 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 9709 |  Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151 |
Form | Modified | |
| 188400 | Medical Source Statement of Ability to Do Work-Related Activities (Mental) - SSA-1152 |
Form | Modified |
ICR Details
| Status | RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { b |
|---|---|
| Agency/Subagency | RegInfo.gov Technical Difficulties focusMethod = |
| OMB Control No | 0960-0662 |
| Type of Information Collection | RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { b |
| Previous ICR Reference No | RegInfo.gov Technical Difficulties focusMethod = |
| Agency Tracking No | RegInfo.gov Technical Difficulties focusMethod = |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |