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Federal forms, ICRs, and supporting documents

Information Collection

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

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

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Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Function Report Child - Child Birth to 1st Birthday - SSA-3375
 
No New
 
Required to Obtain or Retain Benefits
 
20 CFR 416.912 20 CFR 416.924a(a)(2)

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

Income Security General Retirement and Disability

 

26,864 0
   
Individuals or Households
 
   90 %

  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 26,864 0 0 26,864 0 0
Annual IC Time Burden (Hours) 40,744 0 0 40,744 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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