OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Function Report - Adult Third Party

IC 9663 under ICR 202110-0960-003 · OMB 0960-0635.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Privacy Act Statement Revised
Other-Paperworkd Reduction Act (revi
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Function Report - Adult Third Party
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1512 20 CFR 416.912

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-3380 Function Report -- Adult Third Party SSA-3380 (revised).pdf Yes No Fillable Printable
Other-Privacy Act Statement Revised Privacy Act Statement 0635 (revised).docx No   Paper Only
Other-Paperworkd Reduction Act (revised) PRA 0635 (revised).docx No   Paper Only

Income Security General Retirement and Disability

 

709,700 0
   
Individuals or Households
 
   0 %

  Requested 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 709,700 0 0 0 0 709,700
Annual IC Time Burden (Hours) 721,528 0 0 0 0 721,528
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3380 -- Current Version ssa-3380 (current).pdf 07/25/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.