Information Collection

Function Report Child - Child Age 1 to 3rd Birthday - SSA-3376

IC 273031 under ICR 202407-0960-008 · OMB 0960-0542.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3376-BK Function Report Child - Child Age 1 to 3rd Birthday - SSA-3376	Form and Instruction
SSA-3376-BK Function Report Child - Child Age 1 to 3rd Birthday SSA-3376-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 416.924a(a)(2) 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
Form and Instruction	SSA-3376-BK	Function Report Child - Child Age 1 to 3rd Birthday	SSA-3376-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: 53,347

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	53,347	53,347
Annual IC Time Burden (Hours)	80,910	80,910
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.