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0960-0635 - Function Report-Adult Third Party
Removing Inability to Communicate in English as an Education Category
OMB: 0960-0813
IC ID: 234810
OMB.report
SSA
OMB 0960-0813
ICR 202002-0960-008
IC 234810
( )
Documents and Forms
Document Name
Document Type
Form SSA-3380
0960-0635 - Function Report-Adult Third Party
Form
SSA-3380 Function Report - Adult Third Party
SSA-3380 - Revised Version.pdf
Form
Supporting Statement - 0635 (for RIN 0960-AH86).docx
Supporting Statement - 0635 (for RIN 0960-AH86)
IC Document
Addendum - 0635 (for RIN 0960-AH86).docx
Addendum - 0635 (for RIN 0960-AH86)
IC Document
SSA-3380 - Current Version.pdf
SSA-3380 - Current Version
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
0960-0635 - Function Report-Adult Third Party
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 404.1564
20 CFR 416.912
20 CFR 416.964
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-3380
Function Report - Adult Third Party
SSA-3380 - Revised Version.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:
709,700
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
709,700
0
0
709,700
0
0
Annual IC Time Burden (Hours)
721,528
0
0
721,528
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement - 0635 (for RIN 0960-AH86)
Supporting Statement - 0635 (for RIN 0960-AH86).docx
02/25/2020
Addendum - 0635 (for RIN 0960-AH86)
Addendum - 0635 (for RIN 0960-AH86).docx
02/25/2020
SSA-3380 - Current Version
SSA-3380 - Current Version.pdf
01/31/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.