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ICR 202101-0960-006

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0960-0662 can be found here:

Forms and Documents

Document Name	Status
Form HA-1151-BK Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151 Form	Modified
Form HA-1152 Medical Source Statement of Ability to Do Work-Related Activities (Mental) - SSA-1152 Form	Modified
Supporting Statement - 0662.docx Supporting Statement A	2021-01-28
Addendum - 0662.docx Supplementary Document	2021-01-28

IC Document Collections

IC ID	Document Title	Status
9709	Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151 Form	Modified
188400	Medical Source Statement of Ability to Do Work-Related Activities (Mental) - SSA-1152 Form	Modified

ICR Details