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ICR 202010-0960-007

OMB: 0960-0720

Federal Form Document

Forms and Documents

Document Name	Status
Form SSA-3830 Certification of Low Birth Weight for SSI Eligibility Form	Modified
Addendum - 0720.docx Supplementary Document	2021-01-28
Supporting Statement - 0720.docx Supporting Statement A	2021-01-28

IC Document Collections

IC ID	Document Title	Status
9777	Certification of Low Birth Weight for SSI Eligibility Form	Modified