Information Collection

Disability Report - Adult, 20 CFR 404.1512 and 416.912

IC 9548 under ICR 200412-0960-011 · OMB 0960-0579.

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Information Collection (IC) Details

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IC Title:	Disability Report - Adult, 20 CFR 404.1512 and 416.912	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3368				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,116,667	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 7 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,116,667	0	2,116,667
Annual IC Time Burden (Hours)	2,257,667	42,000	2,215,667
Annual IC Cost Burden (Dollars)	0	0	0

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