Report of Adult Functioning-Employer

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0805 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-3385 Report of Adult Functioning-Employer Form
SSA-3385 Report of Adult Functioning-Employer SSA-3385 (revised).pdf Form
SSA-3385 (current).pdf REPORT OF ADULT FUNCTIONING – EMPLOYER IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Adult Functioning-Employer	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 404.1512 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-3385	Report of Adult Functioning-Employer	SSA-3385 (revised).pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,601	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,601	3,601
Annual IC Time Burden (Hours)	1,200	1,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
REPORT OF ADULT FUNCTIONING – EMPLOYER	SSA-3385 (current).pdf	02/22/2024

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