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Presumptive Disability Recommendation Form
Homeless with Schizophrenia Presumptive Disability (HSPD) Pilot Demonstration
OMB: 0960-0793
IC ID: 201339
OMB.report
SSA
OMB 0960-0793
ICR 201202-0960-005
IC 201339
( )
Documents and Forms
Document Name
Document Type
Presumptive Disability Recommendation Form
Form and Instruction
Schizophrenia Presumptive Disability Recommendation Form
Presumptive Disability Form.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Presumptive Disability Recommendation Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
N/A
Schizophrenia Presumptive Disability Recommendation Form
Presumptive Disability Form.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
16
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
208
0
208
0
0
0
Annual IC Time Burden (Hours)
35
0
35
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.