Questionnaire for Children Claiming SSI Benefits - Intranet Version

Questionnaire for Children Claiming SSI Benefits

Documents and Forms

Document Name Document Type
SSA-3881-BK - Revised Version.pdf Other-Internal Intranet-Based EDCS S
SSA 3881-BK - Revised PA Statement.pdf Other-Revised Privacy Act Statement

Information Collection (IC) Details

IC Title:	Questionnaire for Children Claiming SSI Benefits - Intranet Version	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.912(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Intranet-Based EDCS Screens			SSA-3881-BK - Revised Version.pdf		Yes	Yes	Fillable Fileable Signable
Other-Revised Privacy Act Statement			SSA 3881-BK - Revised PA Statement.pdf		Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52,936	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	52,936	9,186	43,750
Annual IC Time Burden (Hours)	84,698	62,823	21,875
Annual IC Cost Burden (Dollars)	0	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.