Information Collection Request

Changes to the Information Collection Tools Associated with the Final Rule, Intermediate Improvement to the Disability Adjudication Process, Including How We Consider Past Work (RIN 0960-AI83)

ICR 202404-0960-003 · OMB 0960-0834 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SSA-3368 Disability Report - Adult Form and Instruction Modified Available
Form SSA-3368 0960-0579 SSA-3368 (Paper Form) 404.1560; 416.960 Form and Instruction Modified Repair queued
Form SSA-3369 Work History Report Form and Instruction Modified Available
Form SSA-3369 0960-0578 SSA-3369 (Paper Form) 404.1560; 416.960 Form and Instruction Modified Repair queued
Form HA-4633 Claimant's Work Background Form and Instruction Modified Available
Form HA-4633 0960-0300 HA-4633 (Paper Form) 404.1560; 416.960 Form and Instruction Modified Repair queued
Supporting Statement - 0960-0834 (PRW Final Rule).docx Supporting Statement A Uploaded 2024-04-18 Repair queued
Addendum - 0960-0834 (PRW Final Rule).docx Supplementary Document Uploaded 2024-04-18 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
262612 0960-0579 i3368 (Internet Screens), 404.1560; 416.960 Other-Internet Screens Modified
262477 0960-0579 SSA-3368 (EDCS Screens) 404.1560; 416.960 Other-Intranet Screens Modified
262476 0960-0579 SSA-3368 (Paper Form) 404.1560; 416.960 Form and Instruction ModifiedDisability Report - Adult
262476 0960-0579 SSA-3368 (Paper Form) 404.1560; 416.960 Form and Instruction Modified
262475 0960-0578 SSA-3369 (EDCS Screens) 404.1560; 416.960 Other-Intranet Screens Modified
262364 0960-0578 SSA-3369 (Paper Form) 404.1560; 416.960 Form and Instruction ModifiedWork History Report
262364 0960-0578 SSA-3369 (Paper Form) 404.1560; 416.960 Form and Instruction Modified
262363 0960-0300 HA-4633 (ERE) 404.1560; 416.960 Other-Internet Screens Modified
262362 0960-0300 HA-4633 (Paper Form) 404.1560; 416.960 Form and Instruction ModifiedClaimant's Work Background
262362 0960-0300 HA-4633 (Paper Form) 404.1560; 416.960 Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2027 36 Months From Approved
4,040,459 0 0
6,040,198 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,040,459 0 0 4,040,459 0 0
Annual Time Burden (Hours) 6,040,198 0 0 6,040,198 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No