OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Medical Permit Parking Application

OMB 0960-0624 ยท SSA.

OMB 0960-0624

SSA employees and contractors with a qualifying medical condition who park at SSA-owned and leased facilities may apply to receive a medical parking permit. SSA uses three forms for this program: (1) SSA-3192, the Application and Statement, which an individual completes when first applying for the medical parking space; (2) SSA-3193, the Physician's Report, which the applicant's physician completes to verify the medical condition; and (3) SSA-3194, Renewal Certification, which medical parking permit holders complete to verify their continued need for the permit. The respondents are SSA employees and contractors seeking medical parking permits, and their physicians. Note: Because SSA employees are Federal workers exempt from the requirements of the Paperwork Reduction Act, the burden below is only for SSA contractors and physicians (of both SSA employees and contractors).

The latest form for Medical Permit Parking Application expires 2026-08-31 and is listed under ICR 202007-0960-006.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-3192 (Contract Application and StatementForm and Instruction
Form SSA-3193 (Physicia Renewal CertificationForm and Instruction
Form SSA-3193 SSA-3193 (Contractor Applicant)Form and Instruction
Supporting Statement - 0624 (final).docxSupporting Statement A
Addendum - 0624 (final).docxSupplementary Document
Application and Statement (Contractor Applicant)- SSA-3192 Form and Instruction
Application and Statement (Contractor Applicant)- SSA-3192 Other-Revised PA Statement
SSA-3193 (Physician) Form and Instruction
SSA-3193 (Physician) Other-Revised PA Statement
SSA-3193 (Contractor Applicant) Form and Instruction
SSA-3193 (Contractor Applicant) Other-Revised PA Statement

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202606-0960-011 Revision of a currently approved collection 2026-07-31
202007-0960-006 Revision of a currently approved collection 2020-11-04
201902-0960-005 No material or nonsubstantive change to a currently approved collection 2019-02-25 Approved without change
201706-0960-005 Revision of a currently approved collection 2017-10-11 Approved without change
201405-0960-003 Revision of a currently approved collection 2014-09-03 Approved without change
201205-0960-009 No material or nonsubstantive change to a currently approved collection 2012-05-15 Approved without change
201106-0960-005 Revision of a currently approved collection 2011-09-15 Approved without change
200808-0960-006 Revision of a currently approved collection 2008-09-02 Approved without change
200612-0960-002 Extension without change of a currently approved collection 2007-03-27 Approved with change
200403-0960-007 Extension without change of a currently approved collection 2004-03-12 Approved without change
200007-0960-007 Existing collection in use without an OMB Control Number 2000-07-28 Approved without change

OMB Details

Application and Statement - SSA-3192

Federal Enterprise Architecture: General Government - Central Personnel

Information collection instruments
FormNameElectronic accessType
Form SSA-3192Application and StatementFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.