Disability Determination Ready Claim (DDRC) Certification Statement (for DDRC Pilot)

Social Security Benefits Application

Documents and Forms

Document Name Document Type
Mock-Up Certification Statement Form - FINAL.pdf www.ssa.gov Other-Certification Statement
Mock-Up Certification Statement Form - FINAL.pdf www.ssa.gov Other-Certification Statement

Information Collection (IC) Details

IC Title:	Disability Determination Ready Claim (DDRC) Certification Statement (for DDRC Pilot)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.310-404.311 20 CFR 404.315-404.322 20 CFR 404.330-404.333 20 CFR 404.601-404.603 20 CFR 404.1501 404.1512

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Certification Statement			Mock-Up Certification Statement Form - FINAL.pdf	www.ssa.gov	No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,008,976	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,008,976	2,008,976
Annual IC Time Burden (Hours)	33,483	33,483
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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