Information Collection

Disability Report - Child (Internet)

IC 179519 under ICR 202402-0960-001 · OMB 0960-0577.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0577 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
i3820 screens (revised).pdf eis.ba.ssa.gov/i3820	Other-Disability Report - Child (Int
i3820 screens (revised).pdf eis.ba.ssa.gov/i3820	Other-Disability Report - Child (Int
i3820 screens (current).pdf Disability Report-Child (Internet)	IC Document
i3820 screens (current).pdf Disability Report-Child (Internet)	IC Document

IC Title:

Disability Report - Child (Internet)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.912

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
Other-Disability Report - Child (Internet)			i3820 screens (revised).pdf	http://eis.ba.ssa.gov/i3820	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 176,572

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 8 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	176,572	176,572
Annual IC Time Burden (Hours)	353,144	353,144
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Disability Report-Child (Internet)	i3820 screens (current).pdf	02/12/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.