Disability Report - Child (Paper) SSA-3820

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⚠️ Notice: This information collection may be referencing outdated material.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
Form SSA-3820-BK Disability Report - Child (Paper) SSA-3820 Form
Form SSA-3820-BK Disability Report - Child (Paper) SSA-3820 Form
0960-0577 Privacy Act Statement (revised).doc Other-Revised Privacy Act Statement
0960-0577 Privacy Act Statement (revised).doc Other-Revised Privacy Act Statement
SSA-3820-BK Disability Report - Child SSA-3820-BK (revised).pdf Form
SSA-3820-BK Disability Report - Child SSA-3820-BK (revised).pdf Form
SSA-3820-BK (current).pdf SSA-3820-BK Disability Report -Child Current Version IC Document
SSA-3820-BK (current).pdf SSA-3820-BK Disability Report -Child Current Version IC Document

Information Collection (IC) Details

IC Title:	Disability Report - Child (Paper) SSA-3820	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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
Form	SSA-3820-BK	Disability Report - Child	SSA-3820-BK (revised).pdf		Yes	No	Fillable Printable
Other-Revised Privacy Act Statement 0577			0960-0577 Privacy Act Statement (revised).doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 177,572	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	177,572	177,572
Annual IC Time Burden (Hours)	266,358	266,358
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-3820-BK Disability Report -Child Current Version	SSA-3820-BK (current).pdf	02/08/2024

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