Information Collection Request

Report of Adult Functioning-Employer

ICR 202608-0960-001 · OMB 0960-0805 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SSA-3385 Report of Adult Functioning-Employer Form Modified Available
Addendum 0805.docx Supplementary Document Uploaded 2026-08-04 Available
Supporting Statement - 0960-0805 (final).docx Supporting Statement A Uploaded 2026-08-27 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
221156 Report of Adult Functioning-Employer Other-Privacy Act Statement (revised) Modified
221156 Report of Adult Functioning-Employer Form ModifiedReport of Adult Functioning-Employer

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 08/31/2026
2,604 3,601
868 1,200
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Report of Adult Functioning-Employer SSA-3385

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,604 3,601 0 0 -997 0
Annual Time Burden (Hours) 868 1,200 0 0 -332 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No