Information Collection

Disability Report - Adult, (i3368PRO)

IC 179421 under ICR 201205-0960-003 · OMB 0960-0579.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0579 can be found here:

Documents and Forms

Document Name Document Type
I3368-PRO screens.pdf secure.ssa.gov/apps6z/i3368PRO/main.html Other-i3368 PRO

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Disability Report - Adult, (i3368PRO)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-i3368 PRO			I3368-PRO screens.pdf	https://secure.ssa.gov/apps6z/i3368PRO/main.html	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,264	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-10,264	10,264
Annual IC Time Burden (Hours)	-15,396	15,396
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.