Medical Report (General)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0052 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-3826 Medical Report (General) Form
SSA-3826 Medical Report (General) SSA-3826 -- Revised Version.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medical Report (General)	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 416.912-416.915 20 CFR 404.1512-404.1515

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3826	Medical Report (General)	SSA-3826 -- Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150,000	-600,000	750,000
Annual IC Time Burden (Hours)	75,000	-300,000	375,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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