Information Collection

Function Report Child - Child Birth to 1st Birthday - SSA-3375

IC 273030 under ICR 202407-0960-008 · OMB 0960-0542.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3375-BK Function Report Child - Child Birth to 1st Birthday - SSA-3375	Form and Instruction
SSA-3375-BK Function Report Child - Child Birth to 1st Birthday SSA-3375-BK.pdf www.ssa.gov	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.912 20 CFR 416.924a(a)(2)

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
Form and Instruction	SSA-3375-BK	Function Report Child - Child Birth to 1st Birthday	SSA-3375-BK.pdf	www.ssa.gov	Yes	No	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26,864

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	26,864	26,864
Annual IC Time Burden (Hours)	40,744	40,744
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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