Information Collection

Certification of Low Birth Weight for SSI Eligibility 20 CFR, 416.931, 416.926a(m)(7) and (8) and 416.924

IC 9777 under ICR 200603-0960-001 · OMB 0960-0720.

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Information Collection (IC) Details

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IC Title:	Certification of Low Birth Weight for SSI Eligibility 20 CFR, 416.931, 416.926a(m)(7) and (8) and 416.924	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-3830				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24,000	24,000
Annual IC Time Burden (Hours)	6,000	6,000
Annual IC Cost Burden (Dollars)	0	0

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