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0960-0578 SSA-3369 (Paper Form) 410.1560; 404.1565; 416.960; 416.965
Intermediate Improvement to the Disability Adjudication Process: Including How We Consider Past Work - RIN 0960-AI83
OMB: 0960-0834
IC ID: 262364
OMB.report
SSA
OMB 0960-0834
ICR 202309-0960-005
IC 262364
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0834 can be found here:
2024-04-18 - New collection (Request for a new OMB Control Number)
Documents and Forms
Document Name
Document Type
Form SSA-3369
0960-0578 SSA-3369 (Paper Form) 410.1560; 404.1565; 416.960; 416.965
Form and Instruction
SSA-3369 Work History Report
SSA-3369 (Revised for PRW NPRM).pdf
www.ssa.gov
Form and Instruction
SSA-3369 (Current).pdf
Current SSA-3369
IC Document
Information Collection (IC) Details
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