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Medic Data Collection Form
MEDIC DATA COLLECTION FORM
OMB: 0960-0383
IC ID: 166829
OMB.report
SSA
OMB 0960-0383
ICR 198906-0960-012
IC 166829
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0383 can be found here:
1989-08-25 - No material or nonsubstantive change to a currently approved collection
1989-06-27 - No material or nonsubstantive change to a currently approved collection
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:
MEDIC DATA COLLECTION FORM
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-1419
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
54
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
287,729
0
0
0
0
287,729
Annual IC Time Burden (Hours)
23,977
0
0
0
0
23,977
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.