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Disability Report - Adult, (Fillable PDF)
Disability Report - Adult
OMB: 0960-0579
IC ID: 9548
OMB.report
SSA
OMB 0960-0579
ICR 202508-0960-001
IC 9548
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Disability Report - Adult, (Fillable PDF)
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
20 CFR 404.1512
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
SSA-3368
Disability Report - Adult
SSA-3368-BK - Current Version (showing revisions for the PRW FR).pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
6,045
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
6,045
0
0
0
0
6,045
Annual IC Time Burden (Hours)
13,400
0
0
4,332
0
9,068
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA-3368-BK - Previous Version (prior to the PRW FR)
SSA-3368 - Previous Version (prior to the implementation of the PRW FR).pdf
08/15/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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