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

Disability Report - Child

Documents and Forms

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

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 416.912

Information Collection Instruments:

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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 355,144	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	355,144	355,144
Annual IC Time Burden (Hours)	5,919	5,919
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.