Information Collection

Report of Adult Functioning-Employer

IC 221156 under ICR 202608-0960-001 · OMB 0960-0805.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3385 Report of Adult Functioning-Employer Report of Adult Functioning-Employer	Form
0805 Privacy Act Statement (revised).docx	Other-Privacy Act Statement (revised
SSA-3385 Report of Adult Functioning-Employer SSA-3385 (revised).pdf	Form
SSA-3385 (current).pdf Report of Adult Functioning - Employer (current)	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 404.1512 20 CFR 416.912

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
Form	SSA-3385				Yes	No	Fillable Printable
Other-Privacy Act Statement (revised)					No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,604

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions, Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,604	-997	3,601
Annual IC Time Burden (Hours)	868	-332	1,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Report of Adult Functioning - Employer (current)		08/27/2026

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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