OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Pain Report - Child

IC 9452 under ICR 202112-0960-006 · OMB 0960-0540.

Documents and Forms
Document Name
Document Type
Form
Other-Privacy Act Statement (revised
Other-Paperwork Reduction Act (revis
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Pain Report - Child
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.512 20 CFR 416.912

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-3371-BK Pain Report-Child SSA-3371-BK (revised).pdf No   Paper Only
Other-Privacy Act Statement (revised) 0540 Prvacy Act Statement 0540 (revised).docx No   Paper Only
Other-Paperwork Reduction Act (revised) PRA Statement 0540 (revised).docx No   Paper Only

Income Security General Retirement and Disability

 

1,500 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 1,500 0 0 -248,500 0 250,000
Annual IC Time Burden (Hours) 1,725 0 0 -60,775 0 62,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-3371 SSA-3371-BK (current).pdf 02/01/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.