Disability Report - Child (Internet)

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⚠️ Notice: This information collection may be referencing outdated material.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
i3820 screens (revised).pdf eis.ba.ssa.gov/i3820 Other-Disability Report - Child (Int
i3820 screens (current).pdf i3820 internet screens (current) IC Document

Information Collection (IC) Details

IC Title:	Disability Report - Child (Internet)	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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Disability Report - Child (Internet)			i3820 screens (revised).pdf	http://eis.ba.ssa.gov/i3820	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 119,464	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 8 %

	Approved	Previously Approved
Annual Number of Responses for this IC	119,464	119,464
Annual IC Time Burden (Hours)	238,928	238,928
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
i3820 internet screens (current)	i3820 screens (current).pdf	07/24/2018

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