Information Collection

Questionnaire for Children Claiming SSI Benefits - Intranet Version

IC 250963 under ICR 202408-0960-001 · OMB 0960-0499.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Intranet-Based EDCS Screens					Yes	Yes	Fillable Fileable Signable
Other-Revised Privacy Act Statement					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 %

table that charts list of burden
	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

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.

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