Disability Report - Child (Paper)

Disability Report - Child

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0577 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-3820-BK Disability Report - Child (Paper) Form and Instruction
SSA-3820-BK Disability Report - Child SSA-3820 (revised).pdf Form and Instruction
SSA-3820 (current).pdf SSA-3820 (current) IC Document

Information Collection (IC) Details

IC Title:	Disability Report - Child (Paper)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.912

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-3820-BK	Disability Report - Child	SSA-3820 (revised).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: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	0	500
Annual IC Time Burden (Hours)	750	250	500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-3820 (current)	SSA-3820 (current).pdf	09/12/2013

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