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0960-0579 - SSA-3368 - Disability Report-Adult
Removing Inability to Communicate in English as an Education Category
OMB: 0960-0813
IC ID: 234806
OMB.report
SSA
OMB 0960-0813
ICR 202002-0960-008
IC 234806
( )
Documents and Forms
Document Name
Document Type
Form SSA-3368
0960-0579 - SSA-3368 - Disability Report-Adult
Form
EDCS 3368 Screens.pdf
Other-EDCS Screens
i3368 screenshots.pdf
Other-i3368 Screens
SSA-3368 Disability Report - Adult
SSA-3368 - Revised Version.pdf
Form
Supporting Statement - 0579 (for RIN 0960-AH86).docx
Supporting Statement - 0579 (for RIN 0960-AH86)
IC Document
Addendum - 0579 (for RIN 0960 AH86).docx
Addendum - 0579 (for RIN 0960 AH86)
IC Document
SSA-3368 - Current Version.pdf
SSA-3368 - Current Version
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
0960-0579 - SSA-3368 - Disability Report-Adult
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 416.912
20 CFR 404.1512
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-3368
Disability Report - Adult
SSA-3368 - Revised Version.pdf
No
Paper Only
Other-EDCS Screens
EDCS 3368 Screens.pdf
Yes
Yes
Fillable Fileable Signable
Other-i3368 Screens
i3368 screenshots.pdf
Yes
Yes
Fillable Printable
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:
2,258,510
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
99 %
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
2,258,510
0
0
2,258,510
0
0
Annual IC Time Burden (Hours)
3,387,766
0
0
3,387,766
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement - 0579 (for RIN 0960-AH86)
Supporting Statement - 0579 (for RIN 0960-AH86).docx
02/25/2020
Addendum - 0579 (for RIN 0960 AH86)
Addendum - 0579 (for RIN 0960 AH86).docx
02/25/2020
SSA-3368 - Current Version
SSA-3368 - Current Version.pdf
01/31/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.