Information Collection

Function Report Child - Child Age 3 to 6th Birthday - SSA-3377

IC 273032 under ICR 202407-0960-008 · OMB 0960-0542.

Documents and Forms

Document Name Document Type
Form SSA-3377-BK Function Report Child - Child Age 3 to 6th Birthday - SSA-3377 Form and Instruction
SSA-3377-BK Function Report Child - Child Age 3 to 6th Birthday SSA-3377-BK.pdf www.ssa.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Function Report Child - Child Age 3 to 6th Birthday - SSA-3377	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-3377-BK	Function Report Child - Child Age 3 to 6th Birthday	SSA-3377-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: 108,745	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	108,745	108,745
Annual IC Time Burden (Hours)	164,930	164,930
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.