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⚠️ Notice: This information collection may be referencing outdated material.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
Revised PA Statement - 0577.pdf Other-Revised PA Statement
SSA-3820-BK Disability Report - Child SSA-3820-BK - Revised.pdf Form
SSA-3820-BK - Current.pdf SSA-3820-BK Disability Report - Child Current Version 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	SSA-3820-BK	Disability Report - Child	SSA-3820-BK - Revised.pdf		Yes	No	Fillable Printable
Other-Revised PA Statement			Revised PA Statement - 0577.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 279,002	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	279,002	278,502	500
Annual IC Time Burden (Hours)	418,503	417,753	750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-3820-BK Disability Report - Child Current Version	SSA-3820-BK - Current.pdf	08/22/2016

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